Provider Demographics
NPI:1407853054
Name:LAKEWOOD PHARMACY
Entity type:Organization
Organization Name:LAKEWOOD PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:FARSHAD
Authorized Official - Last Name:CANTRELLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:504-486-5418
Mailing Address - Street 1:241 W HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-1302
Mailing Address - Country:US
Mailing Address - Phone:504-486-5418
Mailing Address - Fax:504-486-5416
Practice Address - Street 1:241 W HARRISON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-1302
Practice Address - Country:US
Practice Address - Phone:504-486-5418
Practice Address - Fax:504-486-5416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty