Healthcare Provider Details

I. General information

NPI: 1992702187
Provider Name (Legal Business Name): JOHN BULL PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 38TH ST
KENNER LA
70065-3510
US

IV. Provider business mailing address

2124 38TH ST
KENNER LA
70065-3510
US

V. Phone/Fax

Practice location:
  • Phone: 504-443-1294
  • Fax: 504-443-1982
Mailing address:
  • Phone: 504-443-1294
  • Fax: 504-443-1982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number4086203001
License Number StateLA

VIII. Authorized Official

Name: MR. JOHN EDWARD BULL
Title or Position: PRESIDENT
Credential: P.D.
Phone: 504-443-1294