Provider Demographics
NPI:1275404378
Name:FTW LAKE CHARLES LLC
Entity type:Organization
Organization Name:FTW LAKE CHARLES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLYNDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:FUSELIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-477-7733
Mailing Address - Street 1:1505 W MCNEESE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4241
Mailing Address - Country:US
Mailing Address - Phone:337-477-7733
Mailing Address - Fax:337-477-6996
Practice Address - Street 1:1505 W MCNEESE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4241
Practice Address - Country:US
Practice Address - Phone:337-477-7733
Practice Address - Fax:337-477-6996
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FTW LAKE CHARLES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-13
Last Update Date:2025-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy