Provider Demographics
NPI:1215014857
Name:GREMILLION'S DRUG STORE INC.
Entity Type:Organization
Organization Name:GREMILLION'S DRUG STORE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-783-5755
Mailing Address - Street 1:401 N PARKERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-5004
Mailing Address - Country:US
Mailing Address - Phone:337-783-5755
Mailing Address - Fax:337-783-9943
Practice Address - Street 1:401 N PARKERSON AVE
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-5004
Practice Address - Country:US
Practice Address - Phone:337-783-5755
Practice Address - Fax:337-783-9943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA436-IR183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1218456Medicaid
LA1215014857Medicare NSC
LA1049140001Medicare ID - Type Unspecified