MEDICARE: JENNINGS FAMILY PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	C002521IR	LA
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1924213	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1932211927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNINGS FAMILY PHARMACY INC

Provider Business Mailing Address
First Line	:	802 N LAKE ARTHUR AVE
Second Line	:
City	:	JENNINGS
State	:	LA
Zip	:	70546-4628
Country	:	US
Telephone Number	:	337-824-0413
Fax Number	:	337-824-5730

Provider Business Practice Location Address
First Line	:	802 N LAKE ARTHUR AVE
Second Line	:
City	:	JENNINGS
State	:	LA
Zip	:	70546-4628
Country	:	US
Telephone Number	:	337-824-0413
Fax Number	:	337-824-5730

Authorized Official
Title or Position	:	OWNER PHARMACIST
Name	:	LOUIS O'CONNOR
Credential	:	RPH
Telephone Number	:	337-824-0413

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	03/07/2023

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