Provider Demographics
NPI:1679038830
Name:COUSHATTA TRIBE OF LOUISIANA
Entity Type:Organization
Organization Name:COUSHATTA TRIBE OF LOUISIANA
Other - Org Name:COUSHATTA HD PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:FUSELIER
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:337-584-1439
Mailing Address - Street 1:2003 C C BEL RD
Mailing Address - Street 2:
Mailing Address - City:ELTON
Mailing Address - State:LA
Mailing Address - Zip Code:70532-5318
Mailing Address - Country:US
Mailing Address - Phone:337-584-1439
Mailing Address - Fax:337-584-1486
Practice Address - Street 1:2003 C C BEL RD
Practice Address - Street 2:
Practice Address - City:ELTON
Practice Address - State:LA
Practice Address - Zip Code:70532-5318
Practice Address - Country:US
Practice Address - Phone:337-584-1439
Practice Address - Fax:337-584-1486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-01
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)