Provider Demographics
NPI:1134296635
Name:S & S PHARMACY OF MONROE LTD
Entity type:Organization
Organization Name:S & S PHARMACY OF MONROE LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIR
Authorized Official - Prefix:
Authorized Official - First Name:SULLIVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:318-387-9608
Mailing Address - Street 1:2951 RENWICK ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-8146
Mailing Address - Country:US
Mailing Address - Phone:318-387-9608
Mailing Address - Fax:318-387-9659
Practice Address - Street 1:2951 RENWICK ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-8146
Practice Address - Country:US
Practice Address - Phone:318-387-9608
Practice Address - Fax:318-387-9659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY001511IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1259063Medicaid
2030939OtherPK
1083290001Medicare NSC