Provider Demographics
NPI:1538195235
Name:FIRST DOSE PHARMACY
Entity type:Organization
Organization Name:FIRST DOSE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCEWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-701-9292
Mailing Address - Street 1:PO BOX 1867
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70073-1867
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5128 LAPALCO BLVD
Practice Address - Street 2:STE D
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4249
Practice Address - Country:US
Practice Address - Phone:504-365-8614
Practice Address - Fax:504-365-8616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAC005498IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1932157OtherOTHER ID NUMBER
LA1274569Medicaid
LA1274569Medicaid