Provider Demographics
NPI:1861736274
Name:FOLSOM FAMILY PHARMACY, INC.
Entity type:Organization
Organization Name:FOLSOM FAMILY PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:WHITMAN
Authorized Official - Last Name:BRANCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-796-3062
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:LA
Mailing Address - Zip Code:70437-0637
Mailing Address - Country:US
Mailing Address - Phone:985-796-3062
Mailing Address - Fax:985-796-9977
Practice Address - Street 1:82150 HIGHWAY 25
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:LA
Practice Address - Zip Code:70437
Practice Address - Country:US
Practice Address - Phone:985-796-3062
Practice Address - Fax:985-796-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.006625-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy