MEDICARE: CENTRAL REXALL DRUGS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PST.011783	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1905732	OTHER	LA	NABP
2	1639165491	OTHER	LA	NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164829891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL REXALL DRUGS, INC

Provider Business Mailing Address
First Line	:	125 E THOMAS ST
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70401-3313
Country	:	US
Telephone Number	:	985-345-5120
Fax Number	:	985-345-5178

Provider Business Practice Location Address
First Line	:	125 E THOMAS ST
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70401-3313
Country	:	US
Telephone Number	:	985-345-5120
Fax Number	:	985-345-5178

Authorized Official
Title or Position	:	COMPOUNDING PHARMACIST
Name	:	MRS. JAN MATHERNE LANTRIP
Credential	:	PD
Telephone Number	:	985-345-5120

Provider Enumeration Date	:	11/24/2014
Last Update Date	:	03/07/2023

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