Provider Demographics
NPI:1801940259
Name:BATON ROUGE SPECIALTY PHARMACY
Entity type:Organization
Organization Name:BATON ROUGE SPECIALTY PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:LIEM
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-929-9912
Mailing Address - Street 1:748 CHEVELLE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6503
Mailing Address - Country:US
Mailing Address - Phone:225-929-9912
Mailing Address - Fax:225-929-9948
Practice Address - Street 1:748 CHEVELLE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6503
Practice Address - Country:US
Practice Address - Phone:225-929-9912
Practice Address - Fax:225-929-9948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 333600000X
LA4592IR3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1929996OtherNCPDP PROVIDER IDENTIFICATION NUMBER
LA1270741Medicaid