Provider Demographics
NPI:1790790673
Name:KIRBY'S FAMILY PHARMACY, INC.
Entity Type:Organization
Organization Name:KIRBY'S FAMILY PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRBY
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:DESORMEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:318-445-2575
Mailing Address - Street 1:1305 WINDSOR PL
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2751
Mailing Address - Country:US
Mailing Address - Phone:318-445-2575
Mailing Address - Fax:318-484-9457
Practice Address - Street 1:1305 WINDSOR PL
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2751
Practice Address - Country:US
Practice Address - Phone:318-445-2575
Practice Address - Fax:318-484-9457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1258563Medicaid
LA1258563Medicaid