Provider Demographics
NPI:1841610151
Name:PEARL RIVER PHARMACY INC.
Entity Type:Organization
Organization Name:PEARL RIVER PHARMACY INC.
Other - Org Name:PEARL RIVER PHARMACY INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUHASKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-795-1395
Mailing Address - Street 1:64060 HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:LA
Mailing Address - Zip Code:70452-3267
Mailing Address - Country:US
Mailing Address - Phone:985-863-6444
Mailing Address - Fax:985-863-6446
Practice Address - Street 1:64060 HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:LA
Practice Address - Zip Code:70452-3267
Practice Address - Country:US
Practice Address - Phone:985-863-6444
Practice Address - Fax:985-863-6446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-25
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY006876IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145425OtherPK