NPIMap

Organization Active NPI

Walter Birdsall Pharmacy Inc

  • Community/Retail Pharmacy
  • Cut Off, LA
National Provider Identifier
1255425666
Registry record updated Apr 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY001188IR Issued in LA
Legal business name
WALTER BIRDSALL PHARMACY INC
Doing business as
Walter Birdsall Pharmacy Inc
Practice address
118 W 111TH St
Cut Off, LA 70345-3620
Phone
(985) 632-5003
Fax
(985) 632-5083
NPI assigned
Oct 3, 2006
Last updated
Apr 4, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2016

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

Authorized official

Name
Walter Birdsall, RPH
Title
President / Pic
Phone
(985) 632-5003

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHY001188IR LA Primary

Addresses

Primary practice location

118 W 111TH St
Cut Off, LA 70345-3620

Mailing address

PO Box 840
Cut Off, LA 70345-0840

Other identifiers 2

IdentifierTypeStateIssuer
2028711OtherPK
1204421MedicaidLA

Other names 1

  • WALTER BIRDSALL PHARMACY INC Doing business as

National Provider Directory

National Provider Directory

Locations

118 W 111th St
Cut Off, LA 70345
Phone (985) 632-5003

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459728000000",
    "number": "1255425666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 840",
            "city": "CUT OFF",
            "state": "LA",
            "postal_code": "703450840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 W 111TH ST",
            "city": "CUT OFF",
            "state": "LA",
            "postal_code": "703453620",
            "telephone_number": "985-632-5003",
            "fax_number": "985-632-5083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALTER BIRDSALL PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2016-04-04",
        "status": "A",
        "authorized_official_last_name": "BIRDSALL",
        "authorized_official_first_name": "WALTER",
        "authorized_official_title_or_position": "PRESIDENT / PIC",
        "authorized_official_telephone_number": "985-632-5003",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "LA",
            "license": "PHY001188IR",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2028711",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1204421",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALTER BIRDSALL PHARMACY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cut Off, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2016; 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.