Provider Demographics
NPI:1417426354
Name:CHURCH POINT DRUG INC
Entity Type:Organization
Organization Name:CHURCH POINT DRUG INC
Other - Org Name:IOWA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:DOUCET
Authorized Official - Last Name:ALLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:337-684-5475
Mailing Address - Street 1:300 N MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:CHURCH POINT
Mailing Address - State:LA
Mailing Address - Zip Code:70525
Mailing Address - Country:US
Mailing Address - Phone:337-422-4022
Mailing Address - Fax:337-684-5562
Practice Address - Street 1:615 E. MILLER AVE
Practice Address - Street 2:
Practice Address - City:IOWA
Practice Address - State:LA
Practice Address - Zip Code:70647
Practice Address - Country:US
Practice Address - Phone:337-422-4022
Practice Address - Fax:337-422-4144
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHURCH POINT DRUG INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-21
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2207083Medicaid