Organization
NORTHSHORE DISCOUNT PHARMACY INC
Active
Other names
NORTHSHORE DISCOUNT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY WENDLING (PRESIDENT)
(601) 403-8662
Entity
Organization
Contact information
Practice address
680 ROBERT BLVD, SLIDELL, LA 70458-1648
(985) 641-5585
(985) 641-2314
Mailing address
130 SUN VALLEY ACRES, POPLARVILLE, MS 39470-6269
(601) 403-8662
(601) 795-0497
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
3721IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1264598
—
LA
01
—
1927586
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/16/2007
Last updated
11/27/2012
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