Provider Demographics
NPI:1720490857
Name:OCHSNER PHARMACY AND WELLNESS LLC
Entity Type:Organization
Organization Name:OCHSNER PHARMACY AND WELLNESS LLC
Other - Org Name:OCHSNER PHARMACY AND WELLNESS - COVINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC. VICE PRESIDENT FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-842-3400
Mailing Address - Street 1:PO BOX 54696
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70154-4696
Mailing Address - Country:US
Mailing Address - Phone:985-871-2549
Mailing Address - Fax:985-871-2523
Practice Address - Street 1:1000 OCHSNER BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8107
Practice Address - Country:US
Practice Address - Phone:985-871-2549
Practice Address - Fax:985-871-2523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-23
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY.006894-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145949OtherPK
LA2202901Medicaid