Organization
ADVANCED SPECIALTY PHARMACY
Active
Other names
ADVANCED SPECIALTY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY DAUZAT RPH (PHARMACY MANGER)
(337) 264-0301
Entity
Organization
Contact information
Practice address
719 COOLIDGE ST, LAFAYETTE, LA 70503-2309
(337) 264-0301
(337) 264-0307
Mailing address
719 COOLIDGE ST, LAFAYETTE, LA 70503-2309
(337) 264-0301
(337) 264-0307
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BD1200X
Dialysis Equipment & Supplies (DME)
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
333600000X
Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
Primary
5601
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1932741
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/13/2006
Last updated
08/06/2009
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