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General NPI Number Information
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NPI Number | 1518395755
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Entity Type | Organization
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Legal Business Name | HAYDELS DRUG STORE #3
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Dates
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Enumeration Date | 10/25/2013
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Last Update Date | 10/25/2013
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Provider Practice Location Address
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Address Line | 4752 HIGHWAY 311 SUITE 100
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City | HOUMA
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State | LA
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Zip | 70360-2810
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Country | US
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Telephone | 985-879-2440
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Fax | 985-879-2967
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Provider Business Mailing Address
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Address Line | 4752 HWY 311 SUITE #100
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City | HOUMA
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State | LA
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Zip | 70360
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Country | US
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Telephone | 985-879-2440
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Fax | 985-879-2967
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. ROBERT PAUL ROCK
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Credential | RPH
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Telephone | 985-879-2440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 10582
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License Number State | LA
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