Provider Demographics
NPI:1982322707
Name:JUSTICE HEALTHCARE CONSULTANT CARE LEARNING CENTER, LLC
Entity type:Organization
Organization Name:JUSTICE HEALTHCARE CONSULTANT CARE LEARNING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:JUSTICE
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:318-469-9615
Mailing Address - Street 1:3048 LINDHOLM ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71108-2614
Mailing Address - Country:US
Mailing Address - Phone:318-469-9615
Mailing Address - Fax:
Practice Address - Street 1:3048 LINDHOLM ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71108-2614
Practice Address - Country:US
Practice Address - Phone:318-469-9615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
014448OtherIRS