Provider Demographics
NPI:1912178294
Name:JOHNS PHARMACY IN ALBANY LLC
Entity Type:Organization
Organization Name:JOHNS PHARMACY IN ALBANY LLC
Other - Org Name:JOHN'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:985-320-3518
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:LA
Mailing Address - Zip Code:70711-0328
Mailing Address - Country:US
Mailing Address - Phone:225-567-1921
Mailing Address - Fax:225-567-1931
Practice Address - Street 1:29148 SOUTH MONTPELIER AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:LA
Practice Address - Zip Code:70711
Practice Address - Country:US
Practice Address - Phone:225-567-1921
Practice Address - Fax:225-567-1931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
LAPHY.005954-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2035610OtherPK
LA1223409Medicaid