Provider Demographics
NPI:1609904044
Name:CHURCH POINT COMMUNITY PHARMACY
Entity Type:Organization
Organization Name:CHURCH POINT COMMUNITY PHARMACY
Other - Org Name:COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BODIN
Authorized Official - Suffix:I
Authorized Official - Credentials:RPH
Authorized Official - Phone:337-684-1911
Mailing Address - Street 1:731 S MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHURCH POINT
Mailing Address - State:LA
Mailing Address - Zip Code:70525-4109
Mailing Address - Country:US
Mailing Address - Phone:337-684-1911
Mailing Address - Fax:337-684-1912
Practice Address - Street 1:731 S MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:CHRUCH POINT
Practice Address - State:LA
Practice Address - Zip Code:70525
Practice Address - Country:US
Practice Address - Phone:337-684-1911
Practice Address - Fax:337-684-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5339-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1931939OtherNCPDP
LA1271918Medicaid
LA1271918Medicaid
LA1931939OtherNCPDP