MEDICARE: JOE N CANAL RPH

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	183500000X	Pharmacist	009647	LA

General Provider Information

NPI Number	:	1881963346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOE N CANAL RPH

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2011
Last Update Date	:	12/29/2011

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Directions to “ JOE N CANAL RPH” Practice Location

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