Provider Demographics
NPI:1124578927
Name:HARDYS DRUG STORE INC
Entity Type:Organization
Organization Name:HARDYS DRUG STORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/CPT
Authorized Official - Prefix:
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:GUILBEAU
Authorized Official - Last Name:LANCLOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-754-5231
Mailing Address - Street 1:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:ARNAUDVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70512-0316
Mailing Address - Country:US
Mailing Address - Phone:337-754-5231
Mailing Address - Fax:337-754-7976
Practice Address - Street 1:123 FUSELIER RD
Practice Address - Street 2:
Practice Address - City:ARNAUDVILLE
Practice Address - State:LA
Practice Address - Zip Code:70512-6134
Practice Address - Country:US
Practice Address - Phone:337-754-5231
Practice Address - Fax:337-754-7976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.000447-IR333600000X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1219339Medicaid
1356420228OtherNPI
1903497OtherNABP