# JAB CLINIC PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CLINIC PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053410811
- **Authorized official:** JEFFREY BENNETT RPH (OWNER)
- **Authorized official phone:** (318) 251-6385

## Contact information

- **Practice address:** 604 BELUE LN, SUITE A, RUSTON, LA 71270-3870
- **Practice address phone:** (318) 251-6385
- **Practice address fax:** (318) 255-7530
- **Mailing address:** 604 BELUE LN, SUITE A, RUSTON, LA 71270-3870
- **Mailing address phone:** (318) 251-6385
- **Mailing address fax:** (318) 255-7530

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHY.003899-IR | LA | Yes |

## Other

- **Enumeration date:** 09/21/2006
- **Last updated:** 10/20/2014