Medic Shop Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY.006069-IR Issued in LA

Legal business name

MEDIC SHOP PHARMACY

Doing business as

Medic Shop Pharmacy

Practice address

1000 Business 190
Covington, LA 70433-3285

Phone

(985) 875-7515

Fax

(985) 875-7544

NPI assigned

Dec 18, 2008

Organization subpart

No

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

Authorized official

Name

Susann Millen

Title

Owner

Phone

(985) 875-7515

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Medic Shop Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1229558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490313600000",
    "number": "1932345048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 BUSINESS 190",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704333285",
            "telephone_number": "985-875-7515",
            "fax_number": "985-875-7544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BUSINESS 190",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704333285",
            "telephone_number": "985-875-7515",
            "fax_number": "985-875-7544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDIC SHOP PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-18",
        "last_updated": "2017-03-24",
        "status": "A",
        "authorized_official_last_name": "MILLEN",
        "authorized_official_first_name": "SUSANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "985-875-7515"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "LA",
            "license": "PHY.006069-IR",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2118384",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medic Shop Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Covington, LA
• Providers in Covington, LA by specialty
• Community/Retail Pharmacy in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2017; 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.