1205716859 NPI number — YOUR COMMUNITY DISCOUNT PHARMACY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205716859 NPI number — YOUR COMMUNITY DISCOUNT PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOUR COMMUNITY DISCOUNT PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205716859
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 RHETT LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTZ
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70068-8958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-258-2922
Provider Business Mailing Address Fax Number:
504-258-2922

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1950 ORMOND BLVD STE C-D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DESTREHAN
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70047-3810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-258-2922
Provider Business Practice Location Address Fax Number:
504-269-3110
Provider Enumeration Date:
09/04/2025

Additional Information

Authorized Official

Authorized Official Last Name:
MERRITT
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
504-258-2922

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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