Provider Demographics
NPI:1356682264
Name:H & W DRUG STORE 2 LLC
Entity Type:Organization
Organization Name:H & W DRUG STORE 2 LLC
Other - Org Name:H & W DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSTON
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-244-3784
Mailing Address - Street 1:5969 LAPALCO BLVD
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-4833
Mailing Address - Country:US
Mailing Address - Phone:504-349-3300
Mailing Address - Fax:504-349-3338
Practice Address - Street 1:5969 LAPALCO BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4833
Practice Address - Country:US
Practice Address - Phone:504-349-3300
Practice Address - Fax:504-349-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY006659IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1936799OtherNCPDP PROVIDER IDENTIFICATION NUMBER