MEDICARE: OLLA PHARMACY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy
2	3336C0003X	Community/Retail Pharmacy	3547	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1902584	OTHER		NABP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215976683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLLA PHARMACY, INC.

Provider Business Mailing Address
First Line	:	104 MOUND ST
Second Line	:
City	:	JONESVILLE
State	:	LA
Zip	:	71343-2319
Country	:	US
Telephone Number	:	318-339-7913
Fax Number	:	318-339-7914

Provider Business Practice Location Address
First Line	:	104 MOUND ST
Second Line	:
City	:	JONESVILLE
State	:	LA
Zip	:	71343-2319
Country	:	US
Telephone Number	:	318-339-7913
Fax Number	:	318-339-7914

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOE N. CANAL
Credential	:	RPH
Telephone Number	:	318-339-7913

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	03/21/2018

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Directions to “OLLA PHARMACY, INC. ” Practice Location

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