Organization
PARK PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE P PRIMEAUX (PHARMACIST IN CHARGE)
(337) 806-9000
Entity
Organization
Contact information
Practice address
4811 AMBASSADOR CAFFERY PKWY STE 101, LAFAYETTE, LA 70508-7266
(337) 806-9000
Mailing address
4811 AMBASSADOR CAFFERY PKWY STE 101, LAFAYETTE, LA 70508-7266
(337) 806-9000
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2202910
—
LA
Enumeration date
12/17/2020
Last updated
05/23/2024
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