Provider Demographics
NPI:1407358484
Name:THE BERNICE PHARMACY INC
Entity Type:Organization
Organization Name:THE BERNICE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
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:71222-7122
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:2018-03-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
LA0075433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2202090Medicaid
LA2206397Medicaid
LA1904223OtherNCPDP
LA1941182OtherNABPNCPDP
LA1941182OtherNABPNCPDP