Provider Demographics
NPI:1790484723
Name:PARKWAY PHARMACY LLC
Entity Type:Organization
Organization Name:PARKWAY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATEEF
Authorized Official - Middle Name:
Authorized Official - Last Name:ODEYEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-812-2305
Mailing Address - Street 1:10374 HIGHWAY 165 N STE C
Mailing Address - Street 2:
Mailing Address - City:STERLINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:71280-3369
Mailing Address - Country:US
Mailing Address - Phone:318-812-2305
Mailing Address - Fax:318-665-0092
Practice Address - Street 1:10374 HIGHWAY 165 N STE C
Practice Address - Street 2:
Practice Address - City:STERLINGTON
Practice Address - State:LA
Practice Address - Zip Code:71280-3369
Practice Address - Country:US
Practice Address - Phone:318-812-2305
Practice Address - Fax:318-665-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA22072425Medicaid