Organization
JAB CLINIC PHARMACY INC
Active
Other names
CLINIC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY BENNETT RPH (OWNER)
(318) 251-6385
Entity
Organization
Contact information
Practice address
604 BELUE LN, SUITE A, RUSTON, LA 71270-3870
(318) 251-6385
(318) 255-7530
Mailing address
604 BELUE LN, SUITE A, RUSTON, LA 71270-3870
(318) 251-6385
(318) 255-7530
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY.003899-IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1264784
—
LA
01
—
2032265
PK
—
Enumeration date
09/21/2006
Last updated
10/20/2014
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