Provider Demographics
NPI:1477997500
Name:CHURCH POINT DRUG INC
Entity Type:Organization
Organization Name:CHURCH POINT DRUG INC
Other - Org Name:STEWART'S DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-824-2311
Mailing Address - Street 1:403 W PLAQUEMINE ST
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-5755
Mailing Address - Country:US
Mailing Address - Phone:337-824-2311
Mailing Address - Fax:337-824-2312
Practice Address - Street 1:403 W PLAQUEMINE ST
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-5755
Practice Address - Country:US
Practice Address - Phone:337-824-2311
Practice Address - Fax:337-824-2312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2022-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
LAPHY006731IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2202197Medicaid
2141421OtherPK