Provider Demographics
NPI:1700989878
Name:TURNER REXALL PHARMACY INC
Entity type:Organization
Organization Name:TURNER REXALL PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THIRD PARTY PLAN COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-993-6000
Mailing Address - Street 1:411 E MAIN ST
Mailing Address - Street 2:PO DRAWER 1003
Mailing Address - City:OAK GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:71263-1003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:411 E MAIN ST
Practice Address - Street 2:PO DRAWER 1003
Practice Address - City:OAK GROVE
Practice Address - State:LA
Practice Address - Zip Code:71263-1003
Practice Address - Country:US
Practice Address - Phone:318-428-4205
Practice Address - Fax:318-428-4207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAC001141IR333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1222208Medicaid
1912636OtherOTHER ID NUMBER-COMMERCIAL NUMBER
LAAT6350514OtherDEA #
1912636OtherOTHER ID NUMBER-COMMERCIAL NUMBER