Provider Demographics
NPI:1841201480
Name:OAKDALE DRUG CO INC
Entity Type:Organization
Organization Name:OAKDALE DRUG CO INC
Other - Org Name:OAKDALE DRUG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER,AO,PIC
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOXEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:318-335-1360
Mailing Address - Street 1:149 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:LA
Mailing Address - Zip Code:71463-3034
Mailing Address - Country:US
Mailing Address - Phone:318-335-1360
Mailing Address - Fax:318-335-9918
Practice Address - Street 1:149 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:LA
Practice Address - Zip Code:71463-3034
Practice Address - Country:US
Practice Address - Phone:318-335-1360
Practice Address - Fax:318-335-9918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
LAPHY.03444-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2029105OtherPK
LA1263737Medicaid
LA1263737Medicaid