Organization
SS BATON ROUGE LLC
Active
Other names
QVL PHARMACY #222
Organization subpart
No
Provider details
NPI number
Authorized official
GARY CHAD COLLINS (CEO)
(214) 624-3050
Entity
Organization
Contact information
Practice address
5454 BLUEBONNET RD, STE H, BATON ROUGE, LA 70809-2986
(225) 767-6329
(225) 767-8726
Mailing address
PO BOX 803493, DALLAS, TX 75380-3493
(214) 624-3073
(214) 989-7986
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5449RC
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1274542
—
LA
01
—
2035022
PK
—
Enumeration date
05/17/2006
Last updated
06/17/2014
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