PF Spam LLC
Organization Active NPI Community/Retail Pharmacy · Independence, LA
NPI 1114000296 · NPPES record last updated Apr 19, 2022
Key facts
- NPI
- 1114000296
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PHY.000204-IR (LA)
- Legal business name
- PF SPAM LLC
- Practice address
- 345 W Railroad Ave
Independence, LA 70443-2292 - Phone
- (985) 878-4401
- Fax
- (985) 878-3657
- NPI assigned
- Oct 23, 2006
- Organization subpart
- No
Authorized official
- Name
- Amber Michelle Gagneaux
- Title
- Supervisor
- Phone
- (985) 878-4401
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 3
Practitioners 5
-
Leslie Cormier, PHARMACIST
-
Tessa McArthur, PHARMD.
-
Amanda Nethery Smith, PHARMD
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Paul'S Pharmacy Independence |
Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200129001448 | LA | Part B Supplier - Mass Immunization (Roster Biller Only) | 2466888136 |
2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Hammond, LA; Loranger, LA; Independence, LA |
| O20221213001114 | LA | DME Supplier - Pharmacy | 2466888136 | Practice locations: Independence, LA |
National Provider Directory
- Tax ID family
- Paul'S Pharmacy 4
Locations
18150 Highway 190 E
Hammond, LA 70401
Phone (985) 345-7122
345 W Railroad Ave
Independence, LA 70443
Phone (985) 809-1515
54033 Highway 1062
Loranger, LA 70446
Phone (985) 878-6622
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PHY.000204-IR | LA | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
345 W Railroad Ave
Independence, LA 70443-2292
Mailing address
PO Box 850
Independence, LA 70443-0850
Phone (985) 878-4401
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2030880 | Other | PK | |
| 1233161 | Medicaid | LA |
Other names
- PAULS PHARMACY
- Paul's Pharmacy Independence
Other providers in Independence, LA
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All providers in Independence, LA · Community/Retail Pharmacy in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 19, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.