1841201480 NPI number — OAKDALE DRUG CO INC

Table of content: (NPI 1841201480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841201480 NPI number — OAKDALE DRUG CO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OAKDALE DRUG CO INC
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:
OAKDALE DRUG COMPANY
Provider Other Organization Name Type Code:
3
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:
1841201480
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
149 HOSPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKDALE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71463-3034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-335-1360
Provider Business Mailing Address Fax Number:
318-335-9918

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
149 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKDALE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71463-3034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-335-1360
Provider Business Practice Location Address Fax Number:
318-335-9918
Provider Enumeration Date:
08/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DOXEY
Authorized Official First Name:
JOHNNY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER,AO,PIC
Authorized Official Telephone Number:
318-335-1360

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHY.03444-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2029105 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1263737 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".