Fountain Park Pharmacy Inc.

Primary specialty

PharmacyTaxonomy code 333600000X

License

114250 Issued in AL

Legal business name

FOUNTAIN PARK PHARMACY INC.

Doing business as

Fountain Park Pharmacy Inc.

Practice address

1901 Manhattan Blvd
Building F Suite 104
Harvey, LA 70058-3582

Phone

(504) 434-4777

Fax

(504) 309-8031

NPI assigned

Sep 19, 2013

Last updated

Sep 1, 2016By 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

Jo Stephanie Culotta, PHARMACIST

Title

Owner/Pharmacist

Phone

(504) 434-4777

Specialties & licenses 9

Addresses

Other identifiers 2

Other names 1

• Fountain Park Pharmacy Inc. Doing business as

Locations

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

{
    "created_epoch": "1379548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472688000000",
    "number": "1407282585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 MANHATTAN BLVD",
            "address_2": "BUILDING F SUITE 104",
            "city": "HARVEY",
            "state": "LA",
            "postal_code": "700583582",
            "telephone_number": "504-434-4777",
            "fax_number": "504-309-8031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 MANHATTAN BLVD",
            "address_2": "BUILDING F SUITE 104",
            "city": "HARVEY",
            "state": "LA",
            "postal_code": "700583582",
            "telephone_number": "504-434-4777",
            "fax_number": "504-309-8031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN PARK PHARMACY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-19",
        "last_updated": "2016-09-01",
        "status": "A",
        "authorized_official_last_name": "CULOTTA",
        "authorized_official_first_name": "JO STEPHANIE",
        "authorized_official_title_or_position": "OWNER/PHARMACIST",
        "authorized_official_telephone_number": "504-434-4777",
        "authorized_official_credential": "PHARMACIST"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "LA",
            "license": "PHY007141IR",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "KY",
            "license": "LA1845",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "TN",
            "license": "5277",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MS",
            "license": "14022/7.1",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "SC",
            "license": "15677",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "KS",
            "license": "22-44626",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "AL",
            "license": "114250",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH27207",
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "GA",
            "license": "PHNR000702",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2142276",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2204238",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fountain Park Pharmacy Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pharmacy in Harvey, LA
• Providers in Harvey, LA by specialty
• Pharmacy in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 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.