Provider Demographics
NPI:1316039522
Name:THE BERNICE PHARMACY INC
Entity Type:Organization
Organization Name:THE BERNICE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:K
Authorized Official - Last Name:KEASTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:318-285-9521
Mailing Address - Street 1:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:BERNICE
Mailing Address - State:LA
Mailing Address - Zip Code:71222-0636
Mailing Address - Country:US
Mailing Address - Phone:318-285-9521
Mailing Address - Fax:318-285-0185
Practice Address - Street 1:417 MAIN ST
Practice Address - Street 2:
Practice Address - City:BERNICE
Practice Address - State:LA
Practice Address - Zip Code:71222
Practice Address - Country:US
Practice Address - Phone:318-285-9521
Practice Address - Fax:318-285-0185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
LA006680IR333600000X, 333600000X
LA3336L0003X
LA5303183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacyGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No3336L0003XSuppliersPharmacyLong Term Care PharmacyGroup - Single Specialty
No183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1904223OtherNABP
LA2202090Medicaid
LA0704010001Medicare NSC