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General NPI Number Information
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NPI Number | 1053665570
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Entity Type | Organization
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Legal Business Name | JENNINGS AMERICAN LEGION HOSPITAL INC
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Dates
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Enumeration Date | 11/06/2012
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Last Update Date | 12/23/2013
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Provider Practice Location Address
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Address Line | 1634 ELTON RD
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City | JENNINGS
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State | LA
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Zip | 70546-3614
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Country | US
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Telephone | 337-616-7371
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Fax | 337-616-7372
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Provider Business Mailing Address
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Address Line | 1634 ELTON RD
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City | JENNINGS
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State | LA
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Zip | 70546-3614
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Country | US
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Telephone | 337-616-7371
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Fax | 337-616-7372
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Authorized Official
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Title or Position | PIC
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Name | BRIAN TRAHAN
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Credential |
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Telephone | 337-616-7371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | PHY.006628-IR
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License Number State | LA
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