Organization
CLAIBORNE LTC PHARMACY, LLC
Active
Other names
Claiborne LTC Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN BANNISTER (MANAGER)
(318) 927-3523
Entity
Organization
Contact information
Practice address
831 W MAIN ST, HOMER, LA 71040-3322
(318) 927-3523
Mailing address
PO BOX 729, BENTON, LA 71006-0729
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2200917
—
LA
Enumeration date
07/18/2017
Last updated
10/02/2020
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