Provider Demographics
NPI:1649291691
Name:D AND L FAMILY DRUG STORE
Entity type:Organization
Organization Name:D AND L FAMILY DRUG STORE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILBEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:337-937-5861
Mailing Address - Street 1:101 E LASTIE ST
Mailing Address - Street 2:
Mailing Address - City:ERATH
Mailing Address - State:LA
Mailing Address - Zip Code:70533-3701
Mailing Address - Country:US
Mailing Address - Phone:337-937-5861
Mailing Address - Fax:337-937-5862
Practice Address - Street 1:101 E LASTIE ST
Practice Address - Street 2:
Practice Address - City:ERATH
Practice Address - State:LA
Practice Address - Zip Code:70533-3701
Practice Address - Country:US
Practice Address - Phone:337-937-5861
Practice Address - Fax:337-937-5862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
LA210IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1211630Medicaid
1902534OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0216060001Medicare NSC