Provider Demographics
NPI:1356878839
Name:HEALTHLOGIC PHARMACY NOLA LLC
Entity type:Organization
Organization Name:HEALTHLOGIC PHARMACY NOLA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-978-3336
Mailing Address - Street 1:11441 INDUSTRIPLEX BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-4268
Mailing Address - Country:US
Mailing Address - Phone:225-978-3336
Mailing Address - Fax:225-663-2478
Practice Address - Street 1:11441 INDUSTRIPLEX BLVD STE 150
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-4299
Practice Address - Country:US
Practice Address - Phone:225-978-3336
Practice Address - Fax:225-663-2478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA49243336C0003X
WVMO05611743336C0003X
RIPHN114623336C0003X
NY364473336C0003X
IN64002500A3336C0003X
GAPHNR0014193336C0003X
KYLA23173336C0003X
OHNRP.022833650-023336C0003X
MDP076583336C0003X
OK99-80733336C0003X
VA02140020013336C0003X
LAPHY.007477-IR3336C0003X
IL0540207193336C0003X
MS166583336C0003X
AROS028583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2169295OtherPK
LA2205269Medicaid