Provider Demographics
NPI:1578642401
Name:ESTHER WANDA INC
Entity Type:Organization
Organization Name:ESTHER WANDA INC
Other - Org Name:KENNER DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:CLARISSE
Authorized Official - Last Name:WANDA
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR OF PHARMACY
Authorized Official - Phone:504-464-4421
Mailing Address - Street 1:3108 LOYOLA DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-4139
Mailing Address - Country:US
Mailing Address - Phone:504-464-4421
Mailing Address - Fax:504-469-5995
Practice Address - Street 1:3108 LOYOLA DR
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-4139
Practice Address - Country:US
Practice Address - Phone:504-464-4421
Practice Address - Fax:504-469-5995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA53193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1271713Medicaid
LA5301770001Medicare NSC