Provider Demographics
NPI:1861775009
Name:GPS ACUTE CARE PHARMACY
Entity type:Organization
Organization Name:GPS ACUTE CARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:225-644-4853
Mailing Address - Street 1:1039 E HIGHWAY 30
Mailing Address - Street 2:SUITE B
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4757
Mailing Address - Country:US
Mailing Address - Phone:225-644-4853
Mailing Address - Fax:
Practice Address - Street 1:1039 E HIGHWAY 30
Practice Address - Street 2:SUITE B
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4757
Practice Address - Country:US
Practice Address - Phone:225-644-4853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA60773336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAFG1271181OtherDEA NUMBER