Healthcare Provider Details

I. General information

NPI: 1912479270
Provider Name (Legal Business Name): H & W DRUG STORE 3
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2018
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 TCHOUPITOULAS ST STE B
NEW ORLEANS LA
70130-1852
US

IV. Provider business mailing address

4718P PARIS AVE
NEW ORLEANS LA
70122-2553
US

V. Phone/Fax

Practice location:
  • Phone: 504-301-2363
  • Fax: 504-302-2320
Mailing address:
  • Phone: 504-301-2363
  • Fax: 504-244-1808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RUSTON HENRY
Title or Position: OWNER
Credential:
Phone: 504-301-2363