Provider Demographics
NPI:1811086002
Name:ROUSES ENTERPRISES LLC
Entity type:Organization
Organization Name:ROUSES ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MNGNG MBR
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROYSTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:985-447-5998
Mailing Address - Street 1:PO BOX 5358
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70302-5358
Mailing Address - Country:US
Mailing Address - Phone:985-447-5998
Mailing Address - Fax:985-447-5563
Practice Address - Street 1:1428 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:LA
Practice Address - Zip Code:70374-3106
Practice Address - Country:US
Practice Address - Phone:985-532-2545
Practice Address - Fax:985-532-5567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY003457IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1263931Medicaid
2033622OtherPK