Provider Demographics
NPI:1992702187
Name:JOHN BULL PHARMACY, INC
Entity type:Organization
Organization Name:JOHN BULL PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BULL
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:504-443-1294
Mailing Address - Street 1:2124 38TH ST
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3510
Mailing Address - Country:US
Mailing Address - Phone:504-443-1294
Mailing Address - Fax:504-443-1982
Practice Address - Street 1:2124 38TH ST
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3510
Practice Address - Country:US
Practice Address - Phone:504-443-1294
Practice Address - Fax:504-443-1982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4086203001333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1253111Medicaid
LA1918018OtherNCPDP
LAFJ0878314OtherDEA NUMBER
LA1253111Medicaid