Provider Demographics
NPI:1639200959
Name:ROUSE'S DISCOUNT PHARMACY
Entity Type:Organization
Organization Name:ROUSE'S DISCOUNT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:KADY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ESCHETE
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:985-873-7482
Mailing Address - Street 1:114 BAYOU BEND DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-1101
Mailing Address - Country:US
Mailing Address - Phone:985-873-7482
Mailing Address - Fax:985-868-7539
Practice Address - Street 1:5818 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-1702
Practice Address - Country:US
Practice Address - Phone:985-873-7482
Practice Address - Fax:985-868-7539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1262064Medicaid