Organization
PARK PHARMACY LLC
Active
Other names
Park Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE PRIMEAUX (OWNER/MANAGER)
(337) 806-9000
Entity
Organization
Contact information
Practice address
4811 AMBASSADOR CAFFERY PKWY STE 101, LAFAYETTE, LA 70508-7266
(337) 806-9000
(337) 806-9074
Mailing address
4811 AMBASSADOR CAFFERY PKWY STE 101, LAFAYETTE, LA 70508-7266
(337) 806-9000
(337) 806-9074
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY006937IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2147229
PK
—
05
—
2202910
—
LA
Enumeration date
07/31/2014
Last updated
12/17/2020
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