Provider Demographics
NPI:1669712154
Name:INNIS PHARMACY LLC
Entity type:Organization
Organization Name:INNIS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MERLIN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LACOMBE
Authorized Official - Suffix:JR
Authorized Official - Credentials:P,D
Authorized Official - Phone:225-202-8424
Mailing Address - Street 1:6430 LA HWY 1
Mailing Address - Street 2:
Mailing Address - City:BATCHELOR
Mailing Address - State:LA
Mailing Address - Zip Code:70715
Mailing Address - Country:US
Mailing Address - Phone:225-202-8424
Mailing Address - Fax:
Practice Address - Street 1:6430 LA HWY 1
Practice Address - Street 2:
Practice Address - City:INNIS
Practice Address - State:LA
Practice Address - Zip Code:70747
Practice Address - Country:US
Practice Address - Phone:225-202-8424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA141143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy