Provider Demographics
NPI:1457420838
Name:GEM DRUGS GRAMERCY INC
Entity type:Organization
Organization Name:GEM DRUGS GRAMERCY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:225-869-3651
Mailing Address - Street 1:PO BOX 1511
Mailing Address - Street 2:
Mailing Address - City:GRAMERCY
Mailing Address - State:LA
Mailing Address - Zip Code:70052-1511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1635 HIGHWAY 3125
Practice Address - Street 2:
Practice Address - City:GRAMERCY
Practice Address - State:LA
Practice Address - Zip Code:70052-3554
Practice Address - Country:US
Practice Address - Phone:225-869-3651
Practice Address - Fax:225-869-8826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 3336I0012X, 3336L0003X, 3336S0011X
LA006246IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2200267Medicaid
1917939OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1917939OtherNCPDP PROVIDER IDENTIFICATION NUMBER