Healthcare Provider Details

I. General information

NPI: 1134145295
Provider Name (Legal Business Name): KAY'S HIDEAWAY PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 OLD STERLINGTON RD STE 3
MONROE LA
71203-2629
US

IV. Provider business mailing address

4140 OLD STERLINGTON RD
MONROE LA
71203-2629
US

V. Phone/Fax

Practice location:
  • Phone: 318-343-4663
  • Fax: 317-343-4691
Mailing address:
  • Phone: 318-343-4777
  • Fax: 318-343-4691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number3929 IR
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number3929 IR
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number3929 IR
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3929-IR
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number3929 IR
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number3929-IR
License Number StateLA
# 7
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number3929-IR
License Number StateLA
# 8
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number3929-IR
License Number StateLA

VIII. Authorized Official

Name: KAY CHANDLER
Title or Position: OWNER
Credential:
Phone: 318-343-4663