Provider Demographics
NPI:1326471541
Name:JOHNRIZK ENTERPRISES LLC
Entity Type:Organization
Organization Name:JOHNRIZK ENTERPRISES LLC
Other - Org Name:BAYOU LACOMBE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-882-6448
Mailing Address - Street 1:62001 OAK POINTE
Mailing Address - Street 2:
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445-5820
Mailing Address - Country:US
Mailing Address - Phone:985-882-6448
Mailing Address - Fax:
Practice Address - Street 1:27431 HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445-6401
Practice Address - Country:US
Practice Address - Phone:985-882-6448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY.006736-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140612OtherPK
LA2202189Medicaid