Healthcare Provider Details

I. General information

NPI: 1457384927
Provider Name (Legal Business Name): FAMILY PHARMACY JONESBORO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ALEXANDER ST
JONESBORO LA
71251-2002
US

IV. Provider business mailing address

500 ALEXANDER ST
JONESBORO LA
71251-2002
US

V. Phone/Fax

Practice location:
  • Phone: 318-259-7334
  • Fax: 318-259-3013
Mailing address:
  • Phone: 318-259-7334
  • Fax: 318-259-3013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4438-IR
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number4438-IR
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number4438-IR
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number4438-IR
License Number StateLA

VIII. Authorized Official

Name: PETER SAAD
Title or Position: PRESIDENT
Credential:
Phone: 318-259-7334