Provider Demographics
NPI:1689767840
Name:HONEYCUTT, LLC.
Entity Type:Organization
Organization Name:HONEYCUTT, LLC.
Other - Org Name:HONEYCUTT DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER/ CPHT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAGENA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:318-793-2400
Mailing Address - Street 1:PO BOX 1350
Mailing Address - Street 2:
Mailing Address - City:JENA
Mailing Address - State:LA
Mailing Address - Zip Code:71342
Mailing Address - Country:US
Mailing Address - Phone:318-992-4574
Mailing Address - Fax:318-992-5635
Practice Address - Street 1:2835 E OAK ST
Practice Address - Street 2:
Practice Address - City:JENA
Practice Address - State:LA
Practice Address - Zip Code:71342-1350
Practice Address - Country:US
Practice Address - Phone:318-992-4574
Practice Address - Fax:318-992-5635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
LA2213IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2028751OtherPK
LA1258211Medicaid
LA1258211Medicaid