Healthcare Provider Details

I. General information

NPI: 1144985839
Provider Name (Legal Business Name): OCEANS HEALTHCARE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W PINHOOK RD STE B
LAFAYETTE LA
70503-2131
US

IV. Provider business mailing address

3905 HEDGCOXE RD UNIT 250249
PLANO TX
75025-0840
US

V. Phone/Fax

Practice location:
  • Phone: 337-233-4656
  • Fax:
Mailing address:
  • Phone: 504-645-8196
  • Fax: 504-348-8354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STUART ARCHER
Title or Position: CEO
Credential:
Phone: 972-464-0022