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General NPI Number Information
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NPI Number | 1508396656
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Entity Type | Organization
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Legal Business Name | BENNIE G. OWENS
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Dates
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Enumeration Date | 06/12/2017
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Last Update Date | 06/12/2017
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Provider Practice Location Address
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Address Line | 204 MAIN ST
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City | LOGANSPORT
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State | LA
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Zip | 71049-2997
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Country | US
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Telephone | 318-697-4381
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Fax | 318-697-5311
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Provider Business Mailing Address
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Address Line | PO BOX 68
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City | LOGANSPORT
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State | LA
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Zip | 71049-0068
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Country | US
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Telephone | 318-697-4381
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Fax |
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | MR. BENNIE G OWENS
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Credential |
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Telephone | 318-697-4381
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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 | 452-IR
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License Number State | LA
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