Healthcare Provider Details

I. General information

NPI: 1265447809
Provider Name (Legal Business Name): B & J PITRE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 11/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13087 W MAIN ST
LAROSE LA
70373-0067
US

IV. Provider business mailing address

PO BOX 67
LAROSE LA
70373-0067
US

V. Phone/Fax

Practice location:
  • Phone: 985-693-7496
  • Fax: 985-798-7997
Mailing address:
  • Phone: 985-693-7496
  • Fax: 985-798-7997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY000895
License Number StateLA

VIII. Authorized Official

Name: BLAKE PITRE
Title or Position: PIC OWNER
Credential:
Phone: 985-876-0507