1457384927 NPI number — FAMILY PHARMACY JONESBORO LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457384927 NPI number — FAMILY PHARMACY JONESBORO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY PHARMACY JONESBORO LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457384927
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 ALEXANDER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71251-2002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-259-7334
Provider Business Mailing Address Fax Number:
318-259-3013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 ALEXANDER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71251-2002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-259-7334
Provider Business Practice Location Address Fax Number:
318-259-3013
Provider Enumeration Date:
07/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SAAD
Authorized Official First Name:
PETER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
318-259-7334

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  4438-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 4438-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 4438-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X , with the licence number: 4438-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7208533140001 . This is a "TRICARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 720853314A . This is a "BCBS DME" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 7208533140 . This is a "BCBS HIT" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1267937 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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