Rxvip la 3 LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

RXVIP LA 3 LLC

Doing business as

PARK PHARMACY

Practice address

4811 Ambassador Caffery Pkwy Ste 101
Lafayette, LA 70508-7266

Phone

(337) 806-9000

Fax

(337) 806-9074

NPI assigned

Jun 12, 2024

Organization subpart

No

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

Authorized official

Name

Shane Primeaux

Title

Pharmacist in Charge

Phone

(337) 806-9000

Specialties & licenses 1

Addresses

Other names 1

• PARK PHARMACY Doing business as

Tax ID family

Park Pharmacy2 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.

• Rxvip la 3 LLC

  • Community/Retail Pharmacy
  • Lafayette, LA
  • NPI 1831931534
  NPD tax ID

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

{
    "created_epoch": "1718150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718150400000",
    "number": "1386486082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4811 AMBASSADOR CAFFERY PKWY STE 101",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705087266",
            "telephone_number": "337-806-9000",
            "fax_number": "337-806-9074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4811 AMBASSADOR CAFFERY PKWY STE 101",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705087266",
            "telephone_number": "337-806-9000",
            "fax_number": "337-806-9074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RXVIP LA 3 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-12",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A",
        "authorized_official_last_name": "PRIMEAUX",
        "authorized_official_first_name": "SHANE",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "337-806-9000"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PARK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• James Kyle Russo II, M.D.
• Jennifer Russo, PMHNP
• Ruth Smothers MD P.C
• Robert A Ruth, DDS
• Ruud Vuijsters RPT Mt Practice of Pain Management Inc
• Rxvip la 3 LLC
• Ryan J Vidrine LLC
• Allie Lacomb Ryan, FNPC
• Joseph C Ryan, MD
• Shakeir Ryan

• Long Term Care Pharmacy in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Long Term Care Pharmacy in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; 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.