Provider Demographics
NPI:1407860307
Name:BUNKIE CITY DRUG, INC.
Entity Type:Organization
Organization Name:BUNKIE CITY DRUG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:JUNEAU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:318-346-6307
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:1010 SHIRLEY ROAD
Mailing Address - City:BUNKIE
Mailing Address - State:LA
Mailing Address - Zip Code:71322-0207
Mailing Address - Country:US
Mailing Address - Phone:318-346-6307
Mailing Address - Fax:318-346-2203
Practice Address - Street 1:1010 SHIRLEY RD
Practice Address - Street 2:
Practice Address - City:BUNKIE
Practice Address - State:LA
Practice Address - Zip Code:71322-1543
Practice Address - Country:US
Practice Address - Phone:318-346-6307
Practice Address - Fax:318-346-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.004234-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1267112Medicaid
LA1132550001Medicare NSC
LA1132550001Medicare ID - Type Unspecified