Provider Demographics
NPI:1518117688
Name:STEWART-JOHNSTON INC
Entity Type:Organization
Organization Name:STEWART-JOHNSTON INC
Other - Org Name:FAMILY VITAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENZINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-259-7334
Mailing Address - Street 1:1231 FARMERVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-3513
Mailing Address - Country:US
Mailing Address - Phone:318-254-0244
Mailing Address - Fax:318-255-2037
Practice Address - Street 1:1231 FARMERVILLE HWY
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3513
Practice Address - Country:US
Practice Address - Phone:318-254-0244
Practice Address - Fax:318-255-2037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
LA6019IR3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1934098OtherNCPDP PROVIDER IDENTIFICATION NUMBER