NPIMap

Organization Active NPI

Icare Pharmacy - Johnston Street LLC

Doing business as iCARE Pharmacy - Johnston St, LLC

  • Community/Retail Pharmacy
  • Lafayette, LA
National Provider Identifier
1073625927
Registry record updated Jul 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY006927IR Issued in LA
Legal business name
ICARE PHARMACY - JOHNSTON STREET LLC
Doing business as
iCARE Pharmacy - Johnston St, LLC
Practice address
2039 Johnston St
Lafayette, LA 70503-2784
Phone
(337) 233-4782
Fax
(337) 233-4783
NPI assigned
Aug 31, 2006
Last updated
Jul 19, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cleveland Michaud
Title
Owner
Phone
(337) 233-4782

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X PHY006927IR LA Primary

Addresses

Primary practice location

2039 Johnston St
Lafayette, LA 70503-2784

Mailing address

2039 Johnston St
Lafayette, LA 70503-2784
Phone (337) 233-4782

Other identifiers 2

IdentifierTypeStateIssuer
2202972MedicaidLA
2147225OtherPK

Other names 1

  • iCARE Pharmacy - Johnston St, LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Icare Johnston Street2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2039 Johnston St
Lafayette, LA 70503
Phone (337) 233-4782

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531958400000",
    "number": "1073625927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2039 JOHNSTON ST",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705032784",
            "telephone_number": "337-233-4782",
            "fax_number": "337-233-4783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2039 JOHNSTON ST",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705032784",
            "telephone_number": "337-233-4782",
            "fax_number": "337-233-4783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICARE PHARMACY - JOHNSTON STREET LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2018-07-19",
        "status": "A",
        "authorized_official_last_name": "MICHAUD",
        "authorized_official_first_name": "CLEVELAND",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "337-233-4782"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "LA",
            "license": "PHY006927IR",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2202972",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2147225",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "iCARE Pharmacy - Johnston St, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lafayette, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.