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General NPI Number Information
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NPI Number | 1962536458
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Entity Type | Organization
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Legal Business Name | NORTHSHORE DISCOUNT PHARMACY, INC
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 680 ROBERT BLVD
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City | SLIDELL
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State | LA
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Zip | 70458-1648
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Country | US
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Telephone | 985-641-5585
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Fax | 985-641-2314
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Provider Business Mailing Address
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Address Line | 680 ROBERT BLVD
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City | SLIDELL
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State | LA
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Zip | 70458-1648
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Country | US
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Telephone | 985-641-5585
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Fax | 985-641-2314
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Authorized Official
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Title or Position | OWNER
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Name | MR. GREGORY JON WENDLING
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Credential | R.PH.
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Telephone | 985-641-5585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 3721
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License Number State | LA
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