=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154920650
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE MEDICINE CABINET OF CALDWELL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2020
-----------------------------------------------------
Last Update Date | 03/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7623 HIGHWAY 165
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-649-6410
-----------------------------------------------------
Fax | 318-649-6442
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7623 HIGHWAY 165
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | DANIELLE NICOLE O'DONNELL
-----------------------------------------------------
Credential | PHARM D
-----------------------------------------------------
Telephone | 318-649-6410
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------