Provider Demographics
NPI:1205395159
Name:LFR ENTERPRISES
Entity Type:Organization
Organization Name:LFR ENTERPRISES
Other - Org Name:FLOYD'S FAMILY PHARMACY #2 (BEDICO)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:985-206-9911
Mailing Address - Street 1:28471 HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-6143
Mailing Address - Country:US
Mailing Address - Phone:985-206-9911
Mailing Address - Fax:985-206-9914
Practice Address - Street 1:28471 HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:PONCHATOULA
Practice Address - State:LA
Practice Address - Zip Code:70454-6143
Practice Address - Country:US
Practice Address - Phone:985-206-9911
Practice Address - Fax:985-206-9914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2207181Medicaid
LACDS.055691-PHYOtherCDS