Provider Demographics
NPI:1801050018
Name:SUMRALLS PHARMACY LLC
Entity type:Organization
Organization Name:SUMRALLS PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LELAND
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMRALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:985-848-7972
Mailing Address - Street 1:30304 HIGHWAY 21
Mailing Address - Street 2:
Mailing Address - City:ANGIE
Mailing Address - State:LA
Mailing Address - Zip Code:70426-4264
Mailing Address - Country:US
Mailing Address - Phone:985-986-4433
Mailing Address - Fax:985-986-4900
Practice Address - Street 1:30304 HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:ANGIE
Practice Address - State:LA
Practice Address - Zip Code:70426-4264
Practice Address - Country:US
Practice Address - Phone:985-986-4433
Practice Address - Fax:985-986-4900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY006037IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2117212OtherPK
LA6159610001Medicare NSC
MS06373397Medicaid
LA1233897Medicaid