Provider Demographics
NPI:1972989242
Name:J AND J ENTERPRISES OF MANDEVILLE,LLC
Entity Type:Organization
Organization Name:J AND J ENTERPRISES OF MANDEVILLE,LLC
Other - Org Name:FAMILY DRUG MART#3
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:YANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-338-7992
Mailing Address - Street 1:2299 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5605
Mailing Address - Country:US
Mailing Address - Phone:985-781-7541
Mailing Address - Fax:985-781-7546
Practice Address - Street 1:2230 GAUSE BLVD E
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4231
Practice Address - Country:US
Practice Address - Phone:985-781-7541
Practice Address - Fax:985-781-7546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY7160IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2203975Medicaid
2153481OtherPK