Provider Demographics
NPI:1841809274
Name:THE BERNICE PHARMACY INC
Entity type:Organization
Organization Name:THE BERNICE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:KEASTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:318-285-9521
Mailing Address - Street 1:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:BERNICE
Mailing Address - State:LA
Mailing Address - Zip Code:71222-0636
Mailing Address - Country:US
Mailing Address - Phone:318-285-9521
Mailing Address - Fax:318-285-0185
Practice Address - Street 1:417 MAIN ST
Practice Address - Street 2:
Practice Address - City:BERNICE
Practice Address - State:LA
Practice Address - Zip Code:71222
Practice Address - Country:US
Practice Address - Phone:318-285-9521
Practice Address - Fax:318-285-0185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy