CHRIS PHARMACY & GIFTS OF PORT VINCENT LLC (CHRIS' PHARMACY IN PORT VINCENT) - NPI NUMBER 1053655993

Summary

Provider Name: CHRIS PHARMACY & GIFTS OF PORT VINCENT LLC (CHRIS' PHARMACY IN PORT VINCENT)

NPI Number: 1053655993

Clasification: Pharmacy (3336C0003X)

Specialization: Community/Retail Pharmacy

Address:
18590 LA HIGHWAY 16 STE 2
PORT VINCENT, LA
ZIP 70726

Phone Number: (225) 698-6888



Detailed Information

CHRIS PHARMACY & GIFTS OF PORT VINCENT LLC is a community/retail pharmacy pharmacy in Port Vincent, LA. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. The assigned NPI number for this provider is 1053655993 and is registered as an organization entity type.
The provider Is Doing Business As Chris' Pharmacy In Port Vincent.

The provider's business address is:

18590 LA HIGHWAY 16 STE 2
PORT VINCENT, LA
ZIP 70726-066
Phone: (225) 698-6888
Fax: (225) 698-6889

The provider's authorized official is Warren Williams .
The authorized official title is Owner and has the following contact phone number (225) 573-4578.

The enumeration date for this NPI number is 11/15/2012 and was last updated on 5/16/2014.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 3336C0003X Pharmacy Community/Retail Pharmacy PHY006627IR LA Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 2138026 OTHER PK
2 2201808 MEDICAID LA

NPI Record

No. Field Name Field Value
1 NPI 1053655993
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name CHRIS PHARMACY & GIFTS OF PORT VINCENT LLC
5 Provider Other Organization Name CHRIS' PHARMACY IN PORT VINCENT
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 18590 LA HIGHWAY 16 STE 2
8 Provider Business Practice Location Address City Name PORT VINCENT
9 Provider Business Practice Location Address State Name LA
10 Provider Business Practice Location Address Postal Code 707268066
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 2256986888
13 Provider Business Practice Location Address Fax Number 2256986889
14 Provider Enumeration Date 11/15/2012
15 Last Update Date 5/16/2014
16 Authorized Official Last Name WILLIAMS
17 Authorized Official First Name WARREN
18 Authorized Official Title or Position OWNER
19 Authorized Official Telephone Number 2255734578
20 Healthcare Provider Taxonomy Code 1 3336C0003X
21 Provider License Number 1 PHY006627IR
22 Provider License Number State Code 1 LA
23 Healthcare Provider Primary Taxonomy Switch 1 Y
24 Other Provider Identifier 1 2138026
25 Other Provider Identifier Type Code 1 01
26 Other Provider Identifier Issuer 1 PK
27 Other Provider Identifier 2 2201808
28 Other Provider Identifier Type Code 2 05
29 Other Provider Identifier State 2 LA
30 Is Organization Subpart N

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This page was last updated on: 7/15/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.