Healthcare Provider Details

I. General information

NPI: 1437668597
Provider Name (Legal Business Name): JBL RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 WEST ESPLANADE AVE SUITE T
KENNER LA
70065
US

IV. Provider business mailing address

2305 WEST ESPLANADE AVE. SUITE T
KENNER LA
70065-3728
US

V. Phone/Fax

Practice location:
  • Phone: 504-305-1745
  • Fax: 504-305-5555
Mailing address:
  • Phone: 504-305-1745
  • Fax: 504-305-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number StateLA

VIII. Authorized Official

Name: LISA MARTINA COMEAUX
Title or Position: PHARMACIST IN CHARGE/OWNER
Credential:
Phone: 504-339-3356