Provider Demographics
NPI:1548823370
Name:PBM SOLUTIONS COUSHATTA LLC
Entity type:Organization
Organization Name:PBM SOLUTIONS COUSHATTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIPPE
Authorized Official - Middle Name:
Authorized Official - Last Name:PUCHEU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-738-4170
Mailing Address - Street 1:287 PANTHER TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:KINDER
Mailing Address - State:LA
Mailing Address - Zip Code:70648
Mailing Address - Country:US
Mailing Address - Phone:337-738-4170
Mailing Address - Fax:337-738-4171
Practice Address - Street 1:287 PANTHER TRAIL DR
Practice Address - Street 2:
Practice Address - City:KINDER
Practice Address - State:LA
Practice Address - Zip Code:70648
Practice Address - Country:US
Practice Address - Phone:337-738-4170
Practice Address - Fax:337-738-4171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA007882OtherLOUISIANA PHARMACY PERMIT
LA007882OtherLOUISIANA PHARMACY PERMIT