Provider Demographics
NPI:1659802239
Name:AIRLINE DRUG INC
Entity Type:Organization
Organization Name:AIRLINE DRUG INC
Other - Org Name:LOUIS & CLARK MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:413-737-7456
Mailing Address - Street 1:980 POQUONNOCK RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-4259
Mailing Address - Country:US
Mailing Address - Phone:860-440-7444
Mailing Address - Fax:860-446-9127
Practice Address - Street 1:980 POQUONNOCK RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4259
Practice Address - Country:US
Practice Address - Phone:860-440-7444
Practice Address - Fax:860-446-9127
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AIRLINE DRUG INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies