Provider Demographics
NPI:1821038571
Name:DRS K L FOURNET B M DEMAHY & A R -
Entity Type:Organization
Organization Name:DRS K L FOURNET B M DEMAHY & A R -
Other - Org Name:HOSPITAL DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:FOURNET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-394-5049
Mailing Address - Street 1:410 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARTINVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70582-4119
Mailing Address - Country:US
Mailing Address - Phone:337-394-5049
Mailing Address - Fax:337-394-5049
Practice Address - Street 1:410 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT MARTINVILLE
Practice Address - State:LA
Practice Address - Zip Code:70582-4119
Practice Address - Country:US
Practice Address - Phone:337-394-5049
Practice Address - Fax:337-394-5049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LA5065IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1911278OtherNCPDP PROVIDER IDENTIFICATION NUMBER
LA1270997Medicaid
LA1270997Medicaid