Healthcare Provider Details

I. General information

NPI: 1467484220
Provider Name (Legal Business Name): HEALTH MART OF LAKE ARTHUR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 04/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N HIGHWAY 26
LAKE ARTHUR LA
70549-3904
US

IV. Provider business mailing address

500 N HIGHWAY 26
LAKE ARTHUR LA
70549-3904
US

V. Phone/Fax

Practice location:
  • Phone: 337-774-6622
  • Fax:
Mailing address:
  • Phone: 337-774-6622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15819
License Number StateLA

VIII. Authorized Official

Name: WESLEY J. DAVID
Title or Position: OWNER/PHARMACIST
Credential:
Phone: 337-774-6622