Provider Demographics
NPI:1578115143
Name:CENTRAL DRUG STORE INC
Entity Type:Organization
Organization Name:CENTRAL DRUG STORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:WHITE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-262-6200
Mailing Address - Street 1:9952 SULLIVAN RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70818-4300
Mailing Address - Country:US
Mailing Address - Phone:225-262-6200
Mailing Address - Fax:225-262-6578
Practice Address - Street 1:9952 SULLIVAN RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70818-4300
Practice Address - Country:US
Practice Address - Phone:225-262-6200
Practice Address - Fax:225-262-6578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-12
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No251G00000XAgenciesHospice Care, Community Based
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1265926Medicaid