Provider Demographics
NPI:1194034660
Name:BANNISTER, JOHN (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BANNISTER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 CARONDELET CT
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5478
Mailing Address - Country:US
Mailing Address - Phone:318-550-5212
Mailing Address - Fax:
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
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA15778OtherSTATE LICENSE