Provider Demographics
NPI:1548730633
Name:MAGNOLIA DRUGS LLC
Entity type:Organization
Organization Name:MAGNOLIA DRUGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:AZUNNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAIDOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-669-9773
Mailing Address - Street 1:1002 BARROW ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-5606
Mailing Address - Country:US
Mailing Address - Phone:985-746-5449
Mailing Address - Fax:985-746-5414
Practice Address - Street 1:1002 BARROW ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-5606
Practice Address - Country:US
Practice Address - Phone:985-746-5449
Practice Address - Fax:985-746-5414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-30
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy