Healthcare Provider Details

I. General information

NPI: 1629069489
Provider Name (Legal Business Name): CONCORDIA DRUG, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 LOUISIANA AVE
FERRIDAY LA
71334-2826
US

IV. Provider business mailing address

114 LOUISIANA AVE
FERRIDAY LA
71334-2826
US

V. Phone/Fax

Practice location:
  • Phone: 318-757-3811
  • Fax: 318-757-4106
Mailing address:
  • Phone: 318-757-3811
  • Fax: 318-757-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2800-IR
License Number StateLA

VIII. Authorized Official

Name: MR. FRANK RANDOLPH SMITH
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 318-757-3811