Provider Demographics
NPI:1750495735
Name:DH BYNUM ENTERPRISES INC
Entity Type:Organization
Organization Name:DH BYNUM ENTERPRISES INC
Other - Org Name:OUACHITA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:
Authorized Official - First Name:DRURY
Authorized Official - Middle Name:
Authorized Official - Last Name:BYNUM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH MBA FASCP
Authorized Official - Phone:318-388-2669
Mailing Address - Street 1:1215 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202-2319
Mailing Address - Country:US
Mailing Address - Phone:318-388-2669
Mailing Address - Fax:318-387-5377
Practice Address - Street 1:1215 ORANGE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-2319
Practice Address - Country:US
Practice Address - Phone:318-388-2669
Practice Address - Fax:318-387-5377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.004297-IR3336C0003X
3336I0012X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2032642OtherPK
LA1267244Medicaid
LA1267244Medicaid