Provider Demographics
NPI:1073970661
Name:NORTH LOUISIANA PHARMACEUTICAL COMPANY INC
Entity Type:Organization
Organization Name:NORTH LOUISIANA PHARMACEUTICAL COMPANY INC
Other - Org Name:CLAIBORNE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BANNISTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:318-927-3523
Mailing Address - Street 1:833 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:LA
Mailing Address - Zip Code:71040-3322
Mailing Address - Country:US
Mailing Address - Phone:318-927-3523
Mailing Address - Fax:318-927-3526
Practice Address - Street 1:833 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:LA
Practice Address - Zip Code:71040-3322
Practice Address - Country:US
Practice Address - Phone:318-927-3523
Practice Address - Fax:318-927-3526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.007234-IR333600000X, 3336C0003X, 3336C0004X, 3336L0003X, 3336S0011X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPHY.007234OtherLA. BOARD OF PHARACY PERMIT #
FN2859885OtherDEA NUMBER