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PARK PHARMACY LLC
NPI 1073109633
Pharmacy - Long Term Care Pharmacy in Lafayette, LA

Active since December 17, 2020CLIA 19D2235127 · Waiver
4811 AMBASSADOR CAFFERY PKWY STE 101, LAFAYETTE, LA 70508(337) 806-9000 Get Directions Write a Review

NPPES record last updated: May 23, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Park Pharmacy Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PARK PHARMACY LLC (NPI 1073109633) is a healthcare organization registered as a long term care pharmacy in Lafayette, Louisiana and active in the NPI registry since December 2020. The organization holds a CLIA Waiver certificate valid through September 6, 2027 and lists Shane P Primeaux, Pharmacist In Charge, as its authorized official.

NPPES Registry Identity

NPI1073109633
Entity TypeOrganization
Primary Taxonomy3336L0003X
Legal Business NamePARK PHARMACY LLC
Location Address4811 AMBASSADOR CAFFERY PKWY STE 101Lafayette, LA 70508-7266
Mailing Address4811 Ambassador Caffery Pkwy Ste 101Lafayette, LA 70508-7266 · (337) 806-9000
Phone(337) 806-9000
Organization SubpartNo
Authorized OfficialShane P PrimeauxPharmacist In Charge · (337) 806-9000
Enumeration DateDecember 17, 2020
Last NPPES UpdateMay 23, 2024
NPPES CertifiedMay 23, 2024
✔ NPI 1073109633 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPharmacy · Long Term Care PharmacySuppliers
Taxonomy Code3336L0003X
Definition

A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.

4811 AMBASSADOR CAFFERY PKWY STE 101, Lafayette, LA 70508
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Other Identifiers 1

Medicaid2202910LA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Antidote Health Plan of Arizona, Inc., Antidote Health Plan of Ohio, Inc., Avera Health Plans and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 19D2235127

Park Pharmacy · Lafayette, LA
Active · expires Sep 6, 2027
CLIA Number19D2235127
Laboratory TypePharmacy
Certificate Effective DateSeptember 7, 2025
Certificate Expiration DateSeptember 6, 2027
Laboratory DirectorShane Primeaux
Laboratory Phone(337) 806-9000
Laboratory LocationPark Pharmacy4811 Ambassador Caffery Pkwy, Suite 101, Lafayette, LA 70508
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. SHANE P PRIMEAUX RPH
Pharmacist
4811 AMBASSADOR CAFFERY PKWY STE 101
LAFAYETTE, LA 70508
Lafayette Parish (337) 806-9000
PARK PHARMACY LLC
Pharmacy (Community/Retail Pharmacy)
4811 AMBASSADOR CAFFERY PKWY STE 101
LAFAYETTE, LA 70508
Lafayette Parish (337) 806-9000
RXVIP LA 3 LLC
Pharmacy (Long Term Care Pharmacy)
4811 AMBASSADOR CAFFERY PKWY STE 101
LAFAYETTE, LA 70508
Lafayette Parish (337) 806-9000
RXVIP LA 3 LLC
Pharmacy (Community/Retail Pharmacy)
4811 AMBASSADOR CAFFERY PKWY STE 101
LAFAYETTE, LA 70508
Lafayette Parish (337) 806-9000
MORGAN H OWENS PHARMD
Pharmacist
4811 AMBASSADOR CAFFERY PKWY STE 101
LAFAYETTE, LA 70508
Lafayette Parish (337) 806-9000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Park Pharmacy LLC's NPI number?

The NPI number for Park Pharmacy LLC is 1073109633. It was assigned to this organization in the NPPES registry on December 17, 2020.

Where is Park Pharmacy LLC located?

Park Pharmacy LLC is located at 4811 Ambassador Caffery Pkwy Ste 101, Lafayette, LA 70508. The listed phone number is (337) 806-9000.

What is Park Pharmacy LLC's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Long Term Care Pharmacy, with taxonomy code 3336L0003X.

Does Park Pharmacy LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 19D2235127) is associated with this NPI, valid through September 6, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Park Pharmacy LLC accept?

Health plans from Antidote Health Plan of Arizona, Inc., Antidote Health Plan of Ohio, Inc., Avera Health Plans, Baylor Scott and White Health Plan and Blue Cross Blue Shield of North Dakota and 12 other insurers list Park Pharmacy LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Park Pharmacy LLC was last updated on May 23, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.