Healthcare Provider Details

I. General information

NPI: 1922030154
Provider Name (Legal Business Name): HEALTH MART OF GUEYDAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MAIN ST
GUEYDAN LA
70542-3530
US

IV. Provider business mailing address

200 MAIN ST
GUEYDAN LA
70542-3530
US

V. Phone/Fax

Practice location:
  • Phone: 337-536-9600
  • Fax: 337-536-9933
Mailing address:
  • Phone: 337-536-9600
  • Fax: 337-536-9933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number006339
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number StateNULL

VIII. Authorized Official

Name: TISHA DUPREE
Title or Position: OWNER/PIC
Credential: RPH
Phone: 337-536-9600