Provider Demographics
NPI:1558476580
Name:SENTRY DRUGS OF MARKSVILLE INC
Entity Type:Organization
Organization Name:SENTRY DRUGS OF MARKSVILLE INC
Other - Org Name:DONS PHARMASAVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:318-253-8747
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-0099
Mailing Address - Country:US
Mailing Address - Phone:318-253-8747
Mailing Address - Fax:318-253-5136
Practice Address - Street 1:134 RUE MEDICINE
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351
Practice Address - Country:US
Practice Address - Phone:318-253-8747
Practice Address - Fax:318-253-5136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
LAPHY.003229-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1274224Medicaid
2032269OtherPK
LA1274224Medicaid