Provider Demographics
NPI:1821081050
Name:TOWNE PHARMACY LLC
Entity Type:Organization
Organization Name:TOWNE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:337-839-8880
Mailing Address - Street 1:103 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-4616
Mailing Address - Country:US
Mailing Address - Phone:337-839-8880
Mailing Address - Fax:337-839-8881
Practice Address - Street 1:103 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-4616
Practice Address - Country:US
Practice Address - Phone:337-839-8880
Practice Address - Fax:337-839-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0066333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2202154Medicaid
LA4480030001Medicare NSC