Healthcare Provider Details

I. General information

NPI: 1043454093
Provider Name (Legal Business Name): THE MEDICAL DEPOT,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 09/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3016 JEAN LAFITTE PKY. STE.B
CHALMETTE LA
70043
US

IV. Provider business mailing address

3016 JEAN LAFITTE PKY. STE.B
CHALMETTE LA
70043
US

V. Phone/Fax

Practice location:
  • Phone: 504-322-2440
  • Fax: 504-333-6077
Mailing address:
  • Phone: 504-322-2440
  • Fax: 504-333-6077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateLA

VIII. Authorized Official

Name: MS. YOLANDA M JENKINS
Title or Position: OWNER
Credential:
Phone: 504-322-2440