Provider Demographics
NPI:1447578935
Name:CPS DRUG STORE LLC
Entity Type:Organization
Organization Name:CPS DRUG STORE LLC
Other - Org Name:CP'S DRUG STORE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:PEPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-732-0444
Mailing Address - Street 1:426 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3710
Mailing Address - Country:US
Mailing Address - Phone:985-732-0444
Mailing Address - Fax:985-735-9513
Practice Address - Street 1:426 AVENUE B
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3710
Practice Address - Country:US
Practice Address - Phone:985-732-0444
Practice Address - Fax:985-735-9513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.006243-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1935064OtherNCPDP PROVIDER IDENTIFICATION NUMBER