Healthcare Provider Details

I. General information

NPI: 1013016070
Provider Name (Legal Business Name): F AND M SPECIALTY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 VILLAGE ST SUITE D
SLIDELL LA
70458-5302
US

IV. Provider business mailing address

118 VILLAGE ST SUITE D
SLIDELL LA
70458-5302
US

V. Phone/Fax

Practice location:
  • Phone: 985-781-6798
  • Fax: 985-781-9580
Mailing address:
  • Phone: 985-781-6798
  • Fax: 985-781-9580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5202-IR
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5202-IR
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number5202-IR
License Number StateLA

VIII. Authorized Official

Name: MR. HENRY FOX SKELTON II
Title or Position: VICE-PRESIDENT
Credential: R.PH.
Phone: 601-939-9353