Provider Demographics
NPI:1265757512
Name:DAUGHTERS OF CHARITY SERVICES PHARMACY
Entity type:Organization
Organization Name:DAUGHTERS OF CHARITY SERVICES PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:504-212-9502
Mailing Address - Street 1:PO BOX 970
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70059-0970
Mailing Address - Country:US
Mailing Address - Phone:504-482-0084
Mailing Address - Fax:
Practice Address - Street 1:111 N CAUSEWAY BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-5450
Practice Address - Country:US
Practice Address - Phone:504-482-0084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAUGHTERS OF CHARITY SERVICES OF NEW ORLEANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-30
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3542IR261QH0100X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service