Provider Demographics
NPI:1295107282
Name:DAVE'S PHARMACY, INC
Entity type:Organization
Organization Name:DAVE'S PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JOUANDOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-340-7516
Mailing Address - Street 1:1220 BARATARIA BLVD
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3702
Mailing Address - Country:US
Mailing Address - Phone:504-340-7516
Mailing Address - Fax:504-340-7587
Practice Address - Street 1:1220 BARATARIA BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3702
Practice Address - Country:US
Practice Address - Phone:504-340-7516
Practice Address - Fax:504-340-7587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3923332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6211320001Medicare NSC