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General NPI Number Information
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NPI Number | 1245529023
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Entity Type | Organization
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Legal Business Name | EGAN DRUG CO
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Dates
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Enumeration Date | 04/01/2011
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Last Update Date | 04/01/2011
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Provider Practice Location Address
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Address Line | 3121 21ST ST
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City | METAIRIE
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State | LA
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Zip | 70002-4916
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Country | US
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Telephone | 504-835-4474
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Fax | 504-833-2363
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Provider Business Mailing Address
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Address Line | 3121 21ST ST
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City | METAIRIE
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State | LA
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Zip | 70002-4916
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Country | US
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Telephone | 504-835-4474
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Fax | 504-833-2363
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Authorized Official
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Title or Position | CONTROLLER
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Name | JEFFREY MARK HATTEN
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Credential | CPA
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Telephone | 504-835-4474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY.006383-IR
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License Number State | LA
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