Provider Demographics
NPI:1851828065
Name:AFFINITY PHARMACY AT OLIVER ROAD
Entity Type:Organization
Organization Name:AFFINITY PHARMACY AT OLIVER ROAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MS
Authorized Official - First Name:DEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEMOINE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:318-807-6254
Mailing Address - Street 1:920 OLIVER ROAD WAITING E
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201
Mailing Address - Country:US
Mailing Address - Phone:318-807-6254
Mailing Address - Fax:318-812-7346
Practice Address - Street 1:920 OLIVER RD WAITING E
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-807-6254
Practice Address - Fax:318-812-7346
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFFINITY HEALTH GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-18
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7479333600000X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA008595OtherLABP