Northside Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY004593IR Issued in LA

Legal business name

NORTHSIDE PHARMACY LLC

Doing business as

Northside Pharmacy

Practice address

2930 Moss St
Ste a
Lafayette, LA 70501-1274

Phone

(337) 232-2666

Fax

(337) 233-5978

NPI assigned

Jan 23, 2007

Last updated

Mar 15, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nolan Courville

Title

Managing Partner

Phone

(337) 232-2666

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• NORTHSIDE PHARMACY Doing business as

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489536000000",
    "number": "1184778532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2930 MOSS ST",
            "address_2": "STE A",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705011274",
            "telephone_number": "337-232-2666",
            "fax_number": "337-233-5978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2930 MOSS ST",
            "address_2": "STE A",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705011274",
            "telephone_number": "337-232-2666",
            "fax_number": "337-233-5978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2017-03-15",
        "status": "A",
        "authorized_official_last_name": "COURVILLE",
        "authorized_official_first_name": "NOLAN",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "337-232-2666"
    },
    "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": "PHY004593IR",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2028323",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1268496",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTHSIDE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Taylor Lyn Norman, MS, RD, LDN
• Jacob Cage Norris
• Shelley Kaye Norris, RNFA
• Northland Hearing Centers, Inc. (Audibel Hearing Center)
• Northside High School Health Clinic
• Northstar Neurology LLC
• Walter Edward Norton, MD
• Hannah Boudreaux Noto, DDS
• Yolanda Marie Notto, M.ED
• Nova Dental Group, LLC

• Community/Retail Pharmacy in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Community/Retail Pharmacy in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2017; 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.