Provider Demographics
NPI:1811434889
Name:CHURCH POINT DRUG INC
Entity type:Organization
Organization Name:CHURCH POINT DRUG INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:DOUCET
Authorized Official - Last Name:ALLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:337-684-5475
Mailing Address - Street 1:514 E RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:WELSH
Mailing Address - State:LA
Mailing Address - Zip Code:70591
Mailing Address - Country:US
Mailing Address - Phone:337-734-3374
Mailing Address - Fax:337-734-2139
Practice Address - Street 1:514 E RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:WELSH
Practice Address - State:LA
Practice Address - Zip Code:70591-4848
Practice Address - Country:US
Practice Address - Phone:337-734-3374
Practice Address - Fax:337-734-2139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY007420IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167452OtherPK