Healthcare Provider Details

I. General information

NPI: 1215976683
Provider Name (Legal Business Name): OLLA PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MOUND ST
JONESVILLE LA
71343-2319
US

IV. Provider business mailing address

104 MOUND ST
JONESVILLE LA
71343-2319
US

V. Phone/Fax

Practice location:
  • Phone: 318-339-7913
  • Fax: 318-339-7914
Mailing address:
  • Phone: 318-339-7913
  • Fax: 318-339-7914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3547
License Number StateLA

VIII. Authorized Official

Name: JOE N. CANAL
Title or Position: PRESIDENT
Credential: RPH
Phone: 318-339-7913