Provider Demographics
NPI:1023327210
Name:ENICKE, JANA C
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:C
Last Name:ENICKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 W MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-2868
Mailing Address - Country:US
Mailing Address - Phone:337-363-6668
Mailing Address - Fax:337-363-5072
Practice Address - Street 1:800 E MAIN ST
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-4618
Practice Address - Country:US
Practice Address - Phone:337-363-9065
Practice Address - Fax:337-363-9402
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14049183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist