Provider Demographics
NPI:1982716833
Name:GEM DRUGS LA PLACE INC
Entity Type:Organization
Organization Name:GEM DRUGS LA PLACE INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOMILA
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:985-652-1245
Mailing Address - Street 1:70 DOMINICAN RD
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-3446
Mailing Address - Country:US
Mailing Address - Phone:985-652-1245
Mailing Address - Fax:
Practice Address - Street 1:70 DOMINICAN RD
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3446
Practice Address - Country:US
Practice Address - Phone:985-652-1245
Practice Address - Fax:985-652-7239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LA1505IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1917256OtherOTHER ID NUMBER-COMMERCIAL NUMBER
LA1251739Medicaid
LA1251739Medicaid
1917256OtherOTHER ID NUMBER-COMMERCIAL NUMBER
LA0207630001Medicare NSC