1760971840 NPI number — MONTECINO DRUGS INC.

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 1760971840 NPI number — MONTECINO DRUGS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTECINO DRUGS 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:
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:
1760971840
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5917 LAPALCO BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARRERO
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70072-4833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
204-343-4822
Provider Business Mailing Address Fax Number:
504-340-3090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5917 LAPALCO BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARRERO
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70072-4833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
204-343-4822
Provider Business Practice Location Address Fax Number:
504-340-3090
Provider Enumeration Date:
05/04/2018

Additional Information

Authorized Official

Authorized Official Last Name:
MONTECINO
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/PHARMACY MANAGRER
Authorized Official Telephone Number:
504-347-0085

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PHY.007687-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2177401 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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