Provider Demographics
NPI:1669521316
Name:PROFESSIONAL CARE PHARMACY, LLC
Entity type:Organization
Organization Name:PROFESSIONAL CARE PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:DOPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-345-2891
Mailing Address - Street 1:1406 LAMY LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3732
Mailing Address - Country:US
Mailing Address - Phone:318-345-2891
Mailing Address - Fax:318-343-0093
Practice Address - Street 1:1406 LAMY LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3732
Practice Address - Country:US
Practice Address - Phone:318-345-2891
Practice Address - Fax:318-343-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1228257Medicaid
C006006-1ROtherLOUISIANA BOARD PHARMACY
C006006-1ROtherLOUISIANA BOARD PHARMACY