Provider Demographics
NPI:1518092436
Name:PEOPLES DRUG STORE INC
Entity Type:Organization
Organization Name:PEOPLES DRUG STORE INC
Other - Org Name:PEOPLES DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-873-8003
Mailing Address - Street 1:7869 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4461
Mailing Address - Country:US
Mailing Address - Phone:985-873-8526
Mailing Address - Fax:985-873-8541
Practice Address - Street 1:101 GOODE ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4443
Practice Address - Country:US
Practice Address - Phone:985-873-8577
Practice Address - Fax:985-873-8541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LA6656IR3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2202430Medicaid
2035605OtherPK
LANONEMedicaid