Provider Demographics
NPI:1104981539
Name:R & E DRUGS LLC
Entity type:Organization
Organization Name:R & E DRUGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PIC
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:II
Authorized Official - Credentials:RPH
Authorized Official - Phone:985-839-4486
Mailing Address - Street 1:PO BOX 771
Mailing Address - Street 2:1919 MAIN ST.
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438-0771
Mailing Address - Country:US
Mailing Address - Phone:985-839-4486
Mailing Address - Fax:985-839-7704
Practice Address - Street 1:1919 MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-3689
Practice Address - Country:US
Practice Address - Phone:985-839-4486
Practice Address - Fax:985-839-7704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 3336L0003X
LA5316IR333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1271683AMedicaid
LA1261783Medicaid
1931787OtherOTHER ID NUMBER-COMMERCIAL NUMBER
LA1271683AMedicaid