Healthcare Provider Details

I. General information

NPI: 1518117688
Provider Name (Legal Business Name): STEWART-JOHNSTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 FARMERVILLE HWY
RUSTON LA
71270-3513
US

IV. Provider business mailing address

1231 FARMERVILLE HWY
RUSTON LA
71270-3513
US

V. Phone/Fax

Practice location:
  • Phone: 318-254-0244
  • Fax: 318-255-2037
Mailing address:
  • Phone: 318-254-0244
  • Fax: 318-255-2037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number6019IR
License Number StateLA

VIII. Authorized Official

Name: LONNIE MENZINA
Title or Position: OWNER
Credential:
Phone: 318-259-7334