Provider Demographics
NPI:1962042028
Name:SOUTHEAST COMMUNITY HEALTH SYSTEMS PHARMACY KENTWOOD
Entity Type:Organization
Organization Name:SOUTHEAST COMMUNITY HEALTH SYSTEMS PHARMACY KENTWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CYPRIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:225-306-2000
Mailing Address - Street 1:PO BOX 770
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-0770
Mailing Address - Country:US
Mailing Address - Phone:225-306-2000
Mailing Address - Fax:225-658-1282
Practice Address - Street 1:721 AVENUE G
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:LA
Practice Address - Zip Code:70444-2601
Practice Address - Country:US
Practice Address - Phone:225-306-2023
Practice Address - Fax:855-842-4231
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEAST COMMUNITY HEALTH SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-07
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy