1538208319 NPI number — MDB DRUGS

Table of content: (NPI 1538208319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538208319 NPI number — MDB DRUGS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MDB DRUGS
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:
6
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:
1538208319
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OBERLIN
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70655-1200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 W 7TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OBERLIN
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-639-2925
Provider Business Practice Location Address Fax Number:
337-639-4260
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BERCOER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PHCST OWNER
Authorized Official Telephone Number:
337-639-2925

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: 4321IR , 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: 1923211 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1267597 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1923211 . This is a "OTHER ID NUMBER" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com