Healthcare Provider Details

I. General information

NPI: 1861028326
Provider Name (Legal Business Name): J WALKER ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3066 HWY 78
LIVONIA LA
70755
US

IV. Provider business mailing address

PO BOX 218
LIVONIA LA
70755-0218
US

V. Phone/Fax

Practice location:
  • Phone: 225-637-2356
  • Fax: 225-637-2855
Mailing address:
  • Phone: 225-637-2356
  • Fax: 225-637-2855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAMES WYATT WALKER
Title or Position: OWNER/PHARMACIST IN CHARGE
Credential:
Phone: 225-637-2356