Healthcare Provider Details

I. General information

NPI: 1700891348
Provider Name (Legal Business Name): HEALTH MART PHARMACY OF JENNINGS L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 ELTON RD STE A
JENNINGS LA
70546-4138
US

IV. Provider business mailing address

1322 ELTON RD STE A
JENNINGS LA
70546-4138
US

V. Phone/Fax

Practice location:
  • Phone: 337-616-9500
  • Fax: 337-616-9555
Mailing address:
  • Phone: 337-616-9500
  • Fax: 337-616-9555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberC005639IR
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WESLEY J DAVID
Title or Position: OWNER
Credential: RPH
Phone: 337-523-1851