Provider Demographics
NPI:1669921672
Name:FAMILYRX LLC
Entity type:Organization
Organization Name:FAMILYRX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESTENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-447-3746
Mailing Address - Street 1:1772 CANAL BLVD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-5238
Mailing Address - Country:US
Mailing Address - Phone:985-447-3746
Mailing Address - Fax:985-449-7521
Practice Address - Street 1:737 PAUL MAILLARD RD
Practice Address - Street 2:STE C
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070
Practice Address - Country:US
Practice Address - Phone:985-785-6213
Practice Address - Fax:985-785-6575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
LAPHY.007424-IR333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2164132OtherPK