Provider Demographics
NPI:1801209051
Name:GULF STATES HEALTH PARTNERS LLC
Entity Type:Organization
Organization Name:GULF STATES HEALTH PARTNERS LLC
Other - Org Name:RX 2 GEAUX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING CONTACT,AO
Authorized Official - Prefix:
Authorized Official - First Name:NIZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIKHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-888-8099
Mailing Address - Street 1:5710 LBJ FWY
Mailing Address - Street 2:SUITE 325
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-6324
Mailing Address - Country:US
Mailing Address - Phone:214-888-8099
Mailing Address - Fax:214-261-2217
Practice Address - Street 1:7855 HOWELL BLVD STE 160
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70807-5257
Practice Address - Country:US
Practice Address - Phone:855-360-1446
Practice Address - Fax:888-489-3558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.007095-IR3336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146165OtherPK