Healthcare Provider Details

I. General information

NPI: 1881626083
Provider Name (Legal Business Name): HEALTH MART OF KAPLAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 N CUSHING AVE
KAPLAN LA
70548-2615
US

IV. Provider business mailing address

818 N CUSHING AVE
KAPLAN LA
70548-2615
US

V. Phone/Fax

Practice location:
  • Phone: 337-643-8883
  • Fax: 337-643-3508
Mailing address:
  • Phone: 337-643-7952
  • Fax: 337-643-7953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY.004411-IR
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WESLEY DAVID
Title or Position: OWNER AND PRESIDENT
Credential: RPH
Phone: 337-643-8883