Provider Demographics
NPI:1356407985
Name:ALPHA PHARMACEUTICAL
Entity type:Organization
Organization Name:ALPHA PHARMACEUTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:SASSONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-832-0614
Mailing Address - Street 1:3813 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121
Mailing Address - Country:US
Mailing Address - Phone:504-832-0614
Mailing Address - Fax:504-832-0614
Practice Address - Street 1:3813 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121
Practice Address - Country:US
Practice Address - Phone:504-832-0614
Practice Address - Fax:504-832-0614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA49821R333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05786860Medicaid
LA1272001Medicaid
MS05786860Medicaid
1929061Medicare UPIN