Provider Demographics
NPI:1689694507
Name:SENTRY DRUGS OF LA INC
Entity Type:Organization
Organization Name:SENTRY DRUGS OF LA INC
Other - Org Name:SENTRY DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-442-4475
Mailing Address - Street 1:1002 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-8343
Mailing Address - Country:US
Mailing Address - Phone:318-442-4475
Mailing Address - Fax:318-484-9438
Practice Address - Street 1:1002 3RD ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8343
Practice Address - Country:US
Practice Address - Phone:318-442-4475
Practice Address - Fax:318-484-9438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0016703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1919008OtherNCPDP PROVIDER IDENTIFICATION NUMBER
LA1253545Medicaid
0843680001Medicare NSC