Provider Demographics
NPI:1538182522
Name:L & P CORP
Entity type:Organization
Organization Name:L & P CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PALANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-887-4008
Mailing Address - Street 1:2175 W TERRA LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2366
Mailing Address - Country:US
Mailing Address - Phone:636-887-4008
Mailing Address - Fax:636-887-4013
Practice Address - Street 1:2175 W TERRA LN
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2366
Practice Address - Country:US
Practice Address - Phone:636-887-4008
Practice Address - Fax:636-887-4013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
MO0031213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2049472OtherPK
MO620243006Medicaid
MO600243000Medicaid
MO600243000Medicaid