Organization
BAQUE ENTERPRISE LLC
Active
Other names
Jefferson Drug Store
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN D BAQUE PHARMACIST (OWNER/PHARMACIST)
(337) 234-1428
Entity
Organization
Contact information
Practice address
620 JEFFERSON BLVD, LAFAYETTE, LA 70501-7206
(337) 234-1428
(337) 234-1429
Mailing address
620 JEFFERSON BLVD, LAFAYETTE, LA 70501-7206
(337) 234-1428
(337) 234-1429
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
11850
LA
Other
Enumeration date
07/02/2014
Last updated
07/02/2014
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