1912479270 NPI number — H & W DRUG STORE 3

Table of content: (NPI 1912479270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912479270 NPI number — H & W DRUG STORE 3

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
H & W DRUG STORE 3
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:
H & W DRUG STORE
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:
1912479270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4718P PARIS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70122-2553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-301-2363
Provider Business Mailing Address Fax Number:
504-244-1808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1667 TCHOUPITOULAS ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70130-1852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-301-2363
Provider Business Practice Location Address Fax Number:
504-302-2320
Provider Enumeration Date:
12/27/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HENRY
Authorized Official First Name:
RUSTON
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
504-301-2363

Provider Taxonomy Codes

  • Taxonomy code: 183500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 053152 . This is a "PK" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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