Healthcare Provider Details

I. General information

NPI: 1427162403
Provider Name (Legal Business Name): JENA PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11973 HWY 84 W
JENA LA
71342-4463
US

IV. Provider business mailing address

PO BOX 589
JENA LA
71342-0589
US

V. Phone/Fax

Practice location:
  • Phone: 318-992-5565
  • Fax: 318-992-5599
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY.005664-IR
License Number StateLA

VIII. Authorized Official

Name: BRANDON POOLE
Title or Position: PIC/OWNER
Credential:
Phone: 318-992-5565