Provider Demographics
NPI:1629069489
Name:CONCORDIA DRUG, INC.
Entity Type:Organization
Organization Name:CONCORDIA DRUG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:318-757-3811
Mailing Address - Street 1:114 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:FERRIDAY
Mailing Address - State:LA
Mailing Address - Zip Code:71334-2826
Mailing Address - Country:US
Mailing Address - Phone:318-757-3811
Mailing Address - Fax:318-757-4106
Practice Address - Street 1:114 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-2826
Practice Address - Country:US
Practice Address - Phone:318-757-3811
Practice Address - Fax:318-757-4106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2800-IR333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1261289Medicaid
LA1088150001Medicare ID - Type Unspecified