Provider Demographics
NPI:1639165491
Name:CENTRAL REXALL DRUGS INC
Entity Type:Organization
Organization Name:CENTRAL REXALL DRUGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERPHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:K
Authorized Official - Last Name:FELLOWS
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:975-345-5120
Mailing Address - Street 1:PO BOX 1318
Mailing Address - Street 2:125 E THOMAS STREET
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-1318
Mailing Address - Country:US
Mailing Address - Phone:985-345-5120
Mailing Address - Fax:985-345-5178
Practice Address - Street 1:125 E THOMAS ST
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-3313
Practice Address - Country:US
Practice Address - Phone:985-345-5120
Practice Address - Fax:985-345-5178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA078776332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1905732OtherNABP NUMBER
LA1207900Medicaid
LA1905732OtherNABP NUMBER