Provider Demographics
NPI:1902385354
Name:WM. ANDRE CENAC, MD APMC
Entity Type:Organization
Organization Name:WM. ANDRE CENAC, MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NCPDP COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-296-3757
Mailing Address - Street 1:200 RITTENHOUSE CIR BLDG UNIT5
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-1619
Mailing Address - Country:US
Mailing Address - Phone:855-296-3757
Mailing Address - Fax:866-740-4689
Practice Address - Street 1:1307 OLD JEANERETTE RD STE 100
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-5801
Practice Address - Country:US
Practice Address - Phone:337-364-3000
Practice Address - Fax:337-364-5333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD017658332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site