# PARK PHARMACY LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Park Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619385812
- **Authorized official:** SHANE PRIMEAUX (OWNER/MANAGER)
- **Authorized official phone:** (337) 806-9000

## Contact information

- **Practice address:** 4811 AMBASSADOR CAFFERY PKWY STE 101, LAFAYETTE, LA 70508-7266
- **Practice address phone:** (337) 806-9000
- **Practice address fax:** (337) 806-9074
- **Mailing address:** 4811 AMBASSADOR CAFFERY PKWY STE 101, LAFAYETTE, LA 70508-7266
- **Mailing address phone:** (337) 806-9000
- **Mailing address fax:** (337) 806-9074

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHY006937IR | LA | Yes |

## Other

- **Enumeration date:** 07/31/2014
- **Last updated:** 12/17/2020