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General NPI Number Information
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NPI Number | 1811219827
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Entity Type | Organization
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Legal Business Name | POINCIANA PHARMACY LLC
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Dates
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Enumeration Date | 02/17/2010
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 1508 CAJUN DR STE A
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City | MAMOU
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State | LA
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Zip | 70554-2400
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Country | US
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Telephone | 337-468-5001
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Fax | 337-468-5102
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Provider Business Mailing Address
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Address Line | 1508 CAJUN DR STE A
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City | MAMOU
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State | LA
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Zip | 70554-2400
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Country | US
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Telephone | 337-468-5001
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Fax | 337-468-5102
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Authorized Official
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Title or Position | PIC
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Name | MR. ROBIN M DESHOTEL
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Credential | RPH
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Telephone | 337-468-5001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PHY.006222-IR
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY.006222-IR
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License Number State | LA
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