Provider Demographics
NPI:1699555649
Name:BON AMI PHARMACY
Entity type:Organization
Organization Name:BON AMI PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:MYLES
Authorized Official - Middle Name:REGAN
Authorized Official - Last Name:STELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-454-6536
Mailing Address - Street 1:120 RUE DE PHARMACIENS
Mailing Address - Street 2:
Mailing Address - City:SCOTT
Mailing Address - State:LA
Mailing Address - Zip Code:70583-4432
Mailing Address - Country:US
Mailing Address - Phone:337-454-6536
Mailing Address - Fax:
Practice Address - Street 1:2825 GRAND POINT HWY LOT 9
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-6972
Practice Address - Country:US
Practice Address - Phone:337-454-6536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BON AMI PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy