Provider Demographics
NPI:1245529023
Name:EGAN DRUG CO
Entity type:Organization
Organization Name:EGAN DRUG CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:HATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:504-835-4474
Mailing Address - Street 1:3121 21ST ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-4916
Mailing Address - Country:US
Mailing Address - Phone:504-835-4474
Mailing Address - Fax:504-833-2363
Practice Address - Street 1:3121 21ST ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4916
Practice Address - Country:US
Practice Address - Phone:504-835-4474
Practice Address - Fax:504-833-2363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.006383-IR333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy