Healthcare Provider Details

I. General information

NPI: 1518074111
Provider Name (Legal Business Name): KAY'S HIDEAWAY PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 FINKS HIDEAWAY RD SUITE 4
MONROE LA
71203-2470
US

IV. Provider business mailing address

PO BOX 5047
MERIDIAN MS
39302-5047
US

V. Phone/Fax

Practice location:
  • Phone: 318-343-4663
  • Fax: 318-343-4691
Mailing address:
  • Phone: 800-447-4095
  • Fax: 601-482-7490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number3929-IR
License Number StateLA

VIII. Authorized Official

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