Healthcare Provider Details

I. General information

NPI: 1164339966
Provider Name (Legal Business Name): EXCELTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 LAKE FOREST BLVD STE F
NEW ORLEANS LA
70127-2609
US

IV. Provider business mailing address

1515 POYDRAS ST STE 1070
NEW ORLEANS LA
70112-4520
US

V. Phone/Fax

Practice location:
  • Phone: 504-620-0500
  • Fax: 504-620-0522
Mailing address:
  • Phone: 504-524-1210
  • Fax: 504-524-1491

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 Number
License Number State

VIII. Authorized Official

Name: MICHAEL ANDRY
Title or Position: EXECUTIVE DIRETOR
Credential:
Phone: 504-524-1210