Provider Demographics
NPI:1700278751
Name:SAMS CLUB PHARMACY 6521
Entity Type:Organization
Organization Name:SAMS CLUB PHARMACY 6521
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-665-4196
Mailing Address - Street 1:2174 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2275
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2174 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2275
Practice Address - Country:US
Practice Address - Phone:985-851-2147
Practice Address - Fax:985-851-2286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty