Provider Demographics
NPI:1619375219
Name:PEGASUS BIOLOGICS, LLC
Entity Type:Organization
Organization Name:PEGASUS BIOLOGICS, LLC
Other - Org Name:PEGASUS PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:BLALOCK
Authorized Official - Last Name:TESTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-281-4408
Mailing Address - Street 1:5700 CITRUS BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-5813
Mailing Address - Country:US
Mailing Address - Phone:504-281-4408
Mailing Address - Fax:
Practice Address - Street 1:5700 CITRUS BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-5813
Practice Address - Country:US
Practice Address - Phone:504-281-4408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.006999-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy