Provider Demographics
NPI:1790872984
Name:CITY PHARMACY AND HOME MEDICAL LLC
Entity Type:Organization
Organization Name:CITY PHARMACY AND HOME MEDICAL LLC
Other - Org Name:CITY PHARMACY AND HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAVITRA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:337-276-4249
Mailing Address - Street 1:1411 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JEANERETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70544-3505
Mailing Address - Country:US
Mailing Address - Phone:337-276-4249
Mailing Address - Fax:337-276-6472
Practice Address - Street 1:1411 MAIN ST
Practice Address - Street 2:
Practice Address - City:JEANERETTE
Practice Address - State:LA
Practice Address - Zip Code:70544-3505
Practice Address - Country:US
Practice Address - Phone:337-276-4249
Practice Address - Fax:337-276-6472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336S0011X
LAPHY005307IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1271853Medicaid
2028748OtherPK
5231990001Medicare NSC