1861931875 NPI number — VIALLON DRUG CO.

Table of content: (NPI 1861931875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861931875 NPI number — VIALLON DRUG CO.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIALLON DRUG CO.
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:
1861931875
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32555 BOWIE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE CASTLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70788-2503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-545-2402
Provider Business Mailing Address Fax Number:
225-545-2903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32555 BOWIE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE CASTLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70788-2503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-545-2402
Provider Business Practice Location Address Fax Number:
225-545-2903
Provider Enumeration Date:
02/23/2017

Additional Information

Authorized Official

Authorized Official Last Name:
VIALLON
Authorized Official First Name:
BRANDY
Authorized Official Middle Name:
Authorized Official Title or Position:
PIC/OWNER
Authorized Official Telephone Number:
225-545-2402

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PHY.007416-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1093727786 . This is a "CURRENT NPI- MEDICAID IS REQUESTING WE GET A NEW ONE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: PHY.007416-IR . This is a "PHARMACY PERMIT NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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