NPIMap

Organization Active NPI

Jab Clinic Pharmacy Inc

Doing business as Clinic Pharmacy

  • Community/Retail Pharmacy
  • Ruston, LA
National Provider Identifier
1053410811
Registry record updated Oct 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY.003899-IR Issued in LA
Legal business name
JAB CLINIC PHARMACY INC
Doing business as
Clinic Pharmacy
Practice address
604 Belue LN
Suite a
Ruston, LA 71270-3870
Phone
(318) 251-6385
Fax
(318) 255-7530
NPI assigned
Sep 21, 2006
Last updated
Oct 20, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeffrey Bennett, RPH
Title
Owner
Phone
(318) 251-6385

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X PHY.003899-IR LA Primary

Addresses

Primary practice location

604 Belue LN
Suite a
Ruston, LA 71270-3870

Mailing address

604 Belue LN
Suite a
Ruston, LA 71270-3870
Phone (318) 251-6385

Other identifiers 2

IdentifierTypeStateIssuer
1264784MedicaidLA
2032265OtherPK

Other names 1

  • CLINIC PHARMACY Doing business as

National Provider Directory

National Provider Directory

Locations

604 Belue Ln
#A
Ruston, LA 71270
Phone (318) 251-6385

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413763200000",
    "number": "1053410811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 BELUE LN",
            "address_2": "SUITE A",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712703870",
            "telephone_number": "318-251-6385",
            "fax_number": "318-255-7530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 BELUE LN",
            "address_2": "SUITE A",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712703870",
            "telephone_number": "318-251-6385",
            "fax_number": "318-255-7530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAB CLINIC PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2014-10-20",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-251-6385",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "LA",
            "license": "PHY.003899-IR",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1264784",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2032265",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CLINIC PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ruston, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.