Provider Demographics
NPI:1417211764
Name:DUPRE OF GONZALES LLC
Entity Type:Organization
Organization Name:DUPRE OF GONZALES LLC
Other - Org Name:DUPRE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-257-1009
Mailing Address - Street 1:6473 HIGHWAY 44
Mailing Address - Street 2:STE 101
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-8179
Mailing Address - Country:US
Mailing Address - Phone:225-257-1009
Mailing Address - Fax:225-257-1017
Practice Address - Street 1:6473 HIGHWAY 44 STE 101
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-8179
Practice Address - Country:US
Practice Address - Phone:225-257-1009
Practice Address - Fax:225-257-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY006599IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2201875Medicaid
2135584OtherPK