Provider Demographics
NPI:1669537098
Name:COMMUNITY PHARMACY NO 1 INC
Entity type:Organization
Organization Name:COMMUNITY PHARMACY NO 1 INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-775-6337
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70704-0176
Mailing Address - Country:US
Mailing Address - Phone:225-775-6337
Mailing Address - Fax:225-775-6323
Practice Address - Street 1:9136 SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70807-4246
Practice Address - Country:US
Practice Address - Phone:225-775-6337
Practice Address - Fax:225-775-6323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
LA2908IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1261661Medicaid
1925366OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1100130001Medicare NSC