Organization
URBAN DRUG STORE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KERMIT LAMAR WALTERS JR. MD (PRESIDENT)
(318) 388-1374
Entity
Organization
Contact information
Practice address
1910 JACKSON ST, MONROE, LA 71202-2532
(318) 388-1374
(318) 398-0888
Mailing address
1910 JACKSON ST, MONROE, LA 71202-2532
(318) 388-1374
(318) 398-0888
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
2328IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1259136
—
LA
01
—
1921938
NABP
—
01
—
2328IR
LICENSE
LA
Enumeration date
09/20/2006
Last updated
08/22/2020
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