Provider Demographics
NPI:1295497550
Name:ANGU PHARMACYLUX LLC
Entity type:Organization
Organization Name:ANGU PHARMACYLUX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-735-6138
Mailing Address - Street 1:911 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELTON
Mailing Address - State:LA
Mailing Address - Zip Code:70532-3228
Mailing Address - Country:US
Mailing Address - Phone:337-584-2256
Mailing Address - Fax:337-584-2499
Practice Address - Street 1:911 MAIN ST
Practice Address - Street 2:
Practice Address - City:ELTON
Practice Address - State:LA
Practice Address - Zip Code:70532-3228
Practice Address - Country:US
Practice Address - Phone:337-584-2256
Practice Address - Fax:337-584-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPHY.008335-IROtherPHARMACY LICENSE
LA2208632Medicaid