Provider Demographics
NPI:1992710529
Name:THE COMPOUNDING PHARMACY OF SCOTT
Entity type:Organization
Organization Name:THE COMPOUNDING PHARMACY OF SCOTT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANTIER
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:337-233-2003
Mailing Address - Street 1:PO BOX 809
Mailing Address - Street 2:
Mailing Address - City:SCOTT
Mailing Address - State:LA
Mailing Address - Zip Code:70583-0809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5900 CAMERON ST
Practice Address - Street 2:STE 100A
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583
Practice Address - Country:US
Practice Address - Phone:337-233-2003
Practice Address - Fax:337-233-3385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
LA5633IR333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1207667Medicaid
1932361OtherOTHER ID NUMBER-COMMERCIAL NUMBER