Provider Demographics
NPI:1568544351
Name:MINSKY-SALEMI INC
Entity Type:Organization
Organization Name:MINSKY-SALEMI INC
Other - Org Name:M & S SUPER DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:318-559-2433
Mailing Address - Street 1:303 N HOOD ST
Mailing Address - Street 2:
Mailing Address - City:LAKE PROVIDENCE
Mailing Address - State:LA
Mailing Address - Zip Code:71254-2141
Mailing Address - Country:US
Mailing Address - Phone:318-559-2433
Mailing Address - Fax:318-559-2437
Practice Address - Street 1:303 N HOOD ST
Practice Address - Street 2:
Practice Address - City:LAKE PROVIDENCE
Practice Address - State:LA
Practice Address - Zip Code:71254-2141
Practice Address - Country:US
Practice Address - Phone:318-559-2433
Practice Address - Fax:318-559-2437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LA4188IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1267279Medicaid
1915062OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1066700001Medicare NSC