Provider Demographics
NPI:1053944512
Name:PORT BARRE PHARMACY LLC
Entity type:Organization
Organization Name:PORT BARRE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:DJAPNI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM MD
Authorized Official - Phone:337-255-4238
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:PORT BARRE
Mailing Address - State:LA
Mailing Address - Zip Code:70577-0550
Mailing Address - Country:US
Mailing Address - Phone:337-585-2382
Mailing Address - Fax:337-585-2385
Practice Address - Street 1:17695 HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:PORT BARRE
Practice Address - State:LA
Practice Address - Zip Code:70577-5178
Practice Address - Country:US
Practice Address - Phone:337-585-2382
Practice Address - Fax:337-585-2385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy