Provider Demographics
NPI:1801972211
Name:FELICIANA PHARMACY, INCORPORATED
Entity type:Organization
Organization Name:FELICIANA PHARMACY, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:225-635-3700
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCISVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70775-0578
Mailing Address - Country:US
Mailing Address - Phone:225-635-3700
Mailing Address - Fax:225-635-3491
Practice Address - Street 1:7189 US HWY 61
Practice Address - Street 2:
Practice Address - City:SAINT FRANCISVILLE
Practice Address - State:LA
Practice Address - Zip Code:72775-0598
Practice Address - Country:US
Practice Address - Phone:225-635-3700
Practice Address - Fax:225-635-3491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA215619Medicaid
LA215619Medicaid