1730416009 NPI number — JAMES DRUG STORE

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 1730416009 NPI number — JAMES DRUG STORE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES DRUG STORE
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:
1730416009
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9889 HOOPER RD
Provider Second Line Business Mailing Address:
APT A4
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70818-4641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-270-2494
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
257 FLORIDA BLVD
Provider Second Line Business Practice Location Address:
SE
Provider Business Practice Location Address City Name:
DENHAM SPRINGS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70726-3728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-665-5186
Provider Business Practice Location Address Fax Number:
225-665-8633
Provider Enumeration Date:
11/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HARRISON
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
LATRAZ
Authorized Official Title or Position:
CERTIFIED PHARMACY TECHNICIAN
Authorized Official Telephone Number:
225-270-2494

Provider Taxonomy Codes

  • Taxonomy code: 183700000X , with the licence number:  006379 , 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)





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