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LINE AVENUE PHARMACY INC NPI 1619058468


NPI Information

NPI: 1619058468
Provider Name: LINE AVENUE PHARMACY INC

Doing Business As: SHREVEPORT NUCLEAR PHARMACY

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

Address:
1822 LINE AVE
SHREVEPORT, LA
ZIP 71101
Phone: (318) 221-5114
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LINE AVENUE PHARMACY INC is a community/retail pharmacy pharmacy in Shreveport, 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. LINE AVENUE PHARMACY INC NPI is 1619058468. The provider is registered as an organization entity type.
The provider Is Doing Business As Shreveport Nuclear Pharmacy.

The provider's business location address is:

1822 LINE AVE
SHREVEPORT, LA
ZIP 71101-612
Phone: (318) 221-5114
Fax: (318) 221-5137

The provider's authorized official is Stephen Randall Caudle .
The authorized official title is President/owner and has the following contact phone number (318) 221-5114.

The enumeration date for this NPI number is 10/18/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
13336C0003XPharmacyCommunity/Retail PharmacyLA 3999-IRLOUISIANAYes
23336N0007XPharmacyNuclear PharmacyLA 4001-NULOUISIANAX

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11266841MEDICAIDLOUISIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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