Healthcare Provider Details

I. General information

NPI: 1699186015
Provider Name (Legal Business Name): ARCHWAY APOTHECARY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42766 MERCHANT ST
PONCHATOULA LA
70454
US

IV. Provider business mailing address

PO BOX 8705
MANDEVILLE LA
70470
US

V. Phone/Fax

Practice location:
  • Phone: 985-801-0804
  • Fax: 985-893-1845
Mailing address:
  • Phone: 985-801-0804
  • Fax: 985-801-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY006821IR
License Number StateLA

VIII. Authorized Official

Name: MR. STEPHEN MARK CAMP
Title or Position: OENER
Credential:
Phone: 985-801-0800