Provider Demographics
NPI:1194902528
Name:MOM & POPS FAMILY PHARMACY
Entity type:Organization
Organization Name:MOM & POPS FAMILY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERROL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DUPLANTINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PD
Authorized Official - Phone:318-578-1096
Mailing Address - Street 1:233 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGHILL
Mailing Address - State:LA
Mailing Address - Zip Code:71075-3207
Mailing Address - Country:US
Mailing Address - Phone:318-539-6337
Mailing Address - Fax:318-539-6556
Practice Address - Street 1:233 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGHILL
Practice Address - State:LA
Practice Address - Zip Code:71075-3207
Practice Address - Country:US
Practice Address - Phone:318-539-6337
Practice Address - Fax:318-578-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15751332BX2000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR168201407Medicaid
LA1226912Medicaid
LA1226912Medicaid