# BAQUE ENTERPRISE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jefferson Drug Store
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831505536
- **Authorized official:** JOHN D BAQUE PHARMACIST (OWNER/PHARMACIST)
- **Authorized official phone:** (337) 234-1428

## Contact information

- **Practice address:** 620 JEFFERSON BLVD, LAFAYETTE, LA 70501-7206
- **Practice address phone:** (337) 234-1428
- **Practice address fax:** (337) 234-1429
- **Mailing address:** 620 JEFFERSON BLVD, LAFAYETTE, LA 70501-7206
- **Mailing address phone:** (337) 234-1428
- **Mailing address fax:** (337) 234-1429

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 11850 | LA | Yes |

## Other

- **Enumeration date:** 07/02/2014
- **Last updated:** 07/02/2014