Healthcare Provider Details

I. General information

NPI: 1912178294
Provider Name (Legal Business Name): JOHNS PHARMACY IN ALBANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 12/01/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29148 SOUTH MONTPELIER AVE
ALBANY LA
70711
US

IV. Provider business mailing address

PO BOX 328
ALBANY LA
70711-0328
US

V. Phone/Fax

Practice location:
  • Phone: 225-567-1921
  • Fax: 225-567-1931
Mailing address:
  • Phone: 225-567-1921
  • Fax: 225-567-1931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY.005954-IR
License Number StateLA

VIII. Authorized Official

Name: JOHN SMITH
Title or Position: OWNER
Credential: RPH
Phone: 985-320-3518