Provider Demographics
NPI:1124016324
Name:BERNARDS FAMILY PHARMACY LLC
Entity Type:Organization
Organization Name:BERNARDS FAMILY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST - OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SALTAFORMAGGIO
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:225-667-4286
Mailing Address - Street 1:PO BOX 710
Mailing Address - Street 2:34876 LA HWY 1019
Mailing Address - City:WATSON
Mailing Address - State:LA
Mailing Address - Zip Code:70786-0710
Mailing Address - Country:US
Mailing Address - Phone:225-667-4286
Mailing Address - Fax:225-664-1682
Practice Address - Street 1:34876 LA HIGHWAY 1019
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70706-0659
Practice Address - Country:US
Practice Address - Phone:225-667-4286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5226-IR183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1271322Medicaid
LA1931496OtherNCPDP
LA5166790001Medicare ID - Type Unspecified