Healthcare Provider Details

I. General information

NPI: 1811434889
Provider Name (Legal Business Name): CHURCH POINT DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 E RUSSELL AVE
WELSH LA
70591-4848
US

IV. Provider business mailing address

514 E RUSSELL AVE
WELSH LA
70591
US

V. Phone/Fax

Practice location:
  • Phone: 337-734-3374
  • Fax: 337-734-2139
Mailing address:
  • Phone: 337-734-3374
  • Fax: 337-734-2139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY007420IR
License Number StateLA

VIII. Authorized Official

Name: NICOLE DOUCET ALLEMAN
Title or Position: OWNER
Credential: RPH
Phone: 337-684-5475