Provider Demographics
NPI:1508853540
Name:HEALTHCARE PHARMACY LLC
Entity Type:Organization
Organization Name:HEALTHCARE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ROBICHAUX
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:318-671-9603
Mailing Address - Street 1:8720 QUIMPER PL STE 300
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5742
Mailing Address - Country:US
Mailing Address - Phone:318-671-9603
Mailing Address - Fax:318-671-1106
Practice Address - Street 1:8720 QUIMPER PL STE 300
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5742
Practice Address - Country:US
Practice Address - Phone:318-671-9603
Practice Address - Fax:318-671-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7465-IR3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336L0003XSuppliersPharmacyLong Term Care PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA7465-IROtherLOUISIANA BOARD OF PHARMACY PERMIT
LA2205161Medicaid
BH7105946OtherDEA
4411120001Medicare ID - Type Unspecified