# IMMUNIZATION SERVICES OF LOUISIANA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407120785
- **Authorized official:** DR. GREGORY GERARD HEDRICK PHARMD (OWNER)
- **Authorized official phone:** (504) 430-3397

## Contact information

- **Practice address:** 1608 DIVISION ST, METAIRIE, LA 70001-2712
- **Practice address phone:** (504) 430-3397
- **Practice address fax:** (504) 828-7640
- **Mailing address:** 1608 DIVISION ST, METAIRIE, LA 70001-2712
- **Mailing address phone:** (504) 430-3397
- **Mailing address fax:** (504) 828-7640

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | 17258 | LA | Yes |

## Other

- **Enumeration date:** 03/03/2012
- **Last updated:** 03/12/2012