Provider Demographics
NPI:1770700460
Name:CENTAL LA STATE HOSPITAL PHARMACY
Entity type:Organization
Organization Name:CENTAL LA STATE HOSPITAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:LINZAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:318-484-6666
Mailing Address - Street 1:244 WEST SHAMROCK ST
Mailing Address - Street 2:P.O. BOX 5031
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360
Mailing Address - Country:US
Mailing Address - Phone:318-484-6666
Mailing Address - Fax:318-484-6339
Practice Address - Street 1:244 WEST SHAMROCK ST
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:318-484-6666
Practice Address - Fax:318-484-6339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAC000150-H283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital