Active NPI
Broad Avenue Pharmacy LLC
- Pharmacy
- New Orleans, LA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- BROAD AVENUE PHARMACY LLC
- Practice address
- 1400 N Broad St
New Orleans, LA 70119-2332 - Phone
- (504) 309-4388
- Fax
- (504) 309-4389
- NPI assigned
- Oct 23, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Phat Quach
- Title
- Pharmacy Manager
- Phone
- (504) 309-4388
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | Primary |
Addresses
Primary practice location
1400 N Broad St
New Orleans, LA 70119-2332
Mailing address
1400 N Broad St
New Orleans, LA 70119-2332
Phone (504) 309-4388
Other names 1
- Broad Avenue Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200518000710 | LA | Part B Supplier - Pharmacy | 7416388988 | Practice locations: New Orleans, LA |
National Provider Directory
National Provider Directory- Tax ID family
- Broad Avenue Pharmacy
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Pharmacist
- New Orleans, LA
- NPI 1396879003
Locations
1400 N Broad St
New Orleans, LA 70119
Phone (504) 309-4388
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacist
- New Orleans, LA
- NPI 1861094575
-
- Pharmacist
- New Orleans, LA
- NPI 1477276988
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540252800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1589241600000",
"number": "1669948162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 N BROAD ST",
"city": "NEW ORLEANS",
"state": "LA",
"postal_code": "701192332",
"telephone_number": "504-309-4388"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 N BROAD ST",
"city": "NEW ORLEANS",
"state": "LA",
"postal_code": "701192332",
"telephone_number": "504-309-4388",
"fax_number": "504-309-4389"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BROAD AVENUE PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-10-23",
"last_updated": "2020-05-12",
"certification_date": "2020-05-12",
"status": "A",
"authorized_official_last_name": "QUACH",
"authorized_official_first_name": "PHAT",
"authorized_official_title_or_position": "PHARMACY MANAGER",
"authorized_official_telephone_number": "504-309-4388"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Broad Avenue Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in New Orleans, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.