Provider Demographics
NPI:1649218728
Name:NORTHEAST LA PHARMACY
Entity Type:Organization
Organization Name:NORTHEAST LA PHARMACY
Other - Org Name:NATIONAL PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR OF OPERATIONS-NOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBICHAUX
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:318-797-9517
Mailing Address - Street 1:8860 QUIMPER PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5686
Mailing Address - Country:US
Mailing Address - Phone:318-797-9517
Mailing Address - Fax:318-212-0057
Practice Address - Street 1:8860 QUIMPER PL
Practice Address - Street 2:SUITE 100
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5686
Practice Address - Country:US
Practice Address - Phone:318-797-9517
Practice Address - Fax:318-212-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY005546IR3336L0003X, 3336L0003X
3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1275221Medicaid
2034907OtherPK
2034907OtherPK