Provider Demographics
NPI:1093727786
Name:VIALLON DRUG CO., INC.
Entity Type:Organization
Organization Name:VIALLON DRUG CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:VIALLON
Authorized Official - Suffix:V
Authorized Official - Credentials:RPH
Authorized Official - Phone:225-545-2402
Mailing Address - Street 1:32555 BOWIE ST
Mailing Address - Street 2:
Mailing Address - City:WHITE CASTLE
Mailing Address - State:LA
Mailing Address - Zip Code:70788-2503
Mailing Address - Country:US
Mailing Address - Phone:225-545-2402
Mailing Address - Fax:225-545-2903
Practice Address - Street 1:32555 BOWIE ST
Practice Address - Street 2:
Practice Address - City:WHITE CASTLE
Practice Address - State:LA
Practice Address - Zip Code:70788-2503
Practice Address - Country:US
Practice Address - Phone:225-545-2402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1254029Medicaid
LA1084790001Medicare NSC