Organization
PREVALENCE HEALTH LLC
Active
Other names
PREVALENCE HEALTH
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE ANTHONY (PRESIDENT)
(601) 981-0070
Entity
Organization
Contact information
Practice address
5323 MACHOST RD, ZACHARY, LA 70791-7232
(225) 658-0608
(225) 654-4282
Mailing address
PO BOX 16665, JACKSON, MS 39236-6665
(601) 981-0070
(601) 981-4513
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5567IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1234061
—
LA
01
—
1930658
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/10/2006
Last updated
05/06/2010
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