Paincourtville Pharmacy Inc.

Primary specialty

PharmacistTaxonomy code 183500000X

License

17136 Issued in LA

Legal business name

PAINCOURTVILLE PHARMACY INC.

Practice address

112 Hwy 403
Paincourtville, LA 70391

Phone

(985) 369-3578

Fax

(985) 369-3579

NPI assigned

Sep 19, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David Sagona Jr.

Title

Owner

Phone

(985) 369-3578

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1124125679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 420",
            "city": "PAINCOURTVILLE",
            "state": "LA",
            "postal_code": "703910420",
            "telephone_number": "985-369-3578",
            "fax_number": "395-369-3579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 HWY 403",
            "city": "PAINCOURTVILLE",
            "state": "LA",
            "postal_code": "70391",
            "telephone_number": "985-369-3578",
            "fax_number": "985-369-3579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAINCOURTVILLE PHARMACY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-19",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SAGONA",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "985-369-3578",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "LA",
            "license": "17136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "1915202",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1234125",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Paincourtville, LA
• Providers in Paincourtville, LA by specialty
• Pharmacist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.