Provider Demographics
NPI:1699186015
Name:ARCHWAY APOTHECARY LLC
Entity Type:Organization
Organization Name:ARCHWAY APOTHECARY LLC
Other - Org Name:ARCHWAY APOTHECARY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-801-0800
Mailing Address - Street 1:PO BOX 5084
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70434-5084
Mailing Address - Country:US
Mailing Address - Phone:985-801-0800
Mailing Address - Fax:985-801-0801
Practice Address - Street 1:2190 MANTON DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-1000
Practice Address - Country:US
Practice Address - Phone:985-801-0800
Practice Address - Fax:985-801-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY006821IR3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145503OtherPK