Provider Demographics
NPI:1760971840
Name:MONTECINO DRUGS INC.
Entity Type:Organization
Organization Name:MONTECINO DRUGS INC.
Other - Org Name:MONTECINO DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACY MANAGRER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTECINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-347-0085
Mailing Address - Street 1:5917 LAPALCO BLVD
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-4833
Mailing Address - Country:US
Mailing Address - Phone:204-343-4822
Mailing Address - Fax:504-340-3090
Practice Address - Street 1:5917 LAPALCO BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4833
Practice Address - Country:US
Practice Address - Phone:204-343-4822
Practice Address - Fax:504-340-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.007687-IR333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177401OtherPK