Provider Demographics
NPI:1255401022
Name:CHITIMACHA PHARMACY
Entity type:Organization
Organization Name:CHITIMACHA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SOILEAU
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:337-923-9955
Mailing Address - Street 1:3231 CHITIMACHA TRAIL
Mailing Address - Street 2:
Mailing Address - City:CHARENTON
Mailing Address - State:LA
Mailing Address - Zip Code:70523
Mailing Address - Country:US
Mailing Address - Phone:337-923-9955
Mailing Address - Fax:337-923-7791
Practice Address - Street 1:3231 CHITIMACHA TRAIL
Practice Address - Street 2:
Practice Address - City:CHARENTON
Practice Address - State:LA
Practice Address - Zip Code:70523
Practice Address - Country:US
Practice Address - Phone:337-923-9955
Practice Address - Fax:337-923-7791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1233978Medicaid