MEDICARE: ELMHS OUTPATIENT PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	006272	LA

General Provider Information

NPI Number	:	1164738035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELMHS OUTPATIENT PHARMACY

Provider Business Mailing Address
First Line	:	PO BOX 498
Second Line	:
City	:	JACKSON
State	:	LA
Zip	:	70748-0498
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4502 HWY 951
Second Line	:	BUILDING 200 NORTH
City	:	JACKSON
State	:	LA
Zip	:	70748-0498
Country	:	US
Telephone Number	:	225-634-0368
Fax Number	:	225-634-0447

Authorized Official
Title or Position	:	PHARMACY DIRECTOR
Name	:	GREGORY DOLESE
Credential	:	R.PH
Telephone Number	:	225-634-0370

Provider Enumeration Date	:	08/30/2010
Last Update Date	:	08/30/2010

Similar Medicare Providers

1043206543 — EAST LOUISIANA STATE HOSPITAL
Practice Location Address:

4502 HIGHWAY 951
JACKSON, LA
70748-0498

Practice Phone: 225-634-0533
Practice Fax: 225-634-5827

1972729127 — EASTERN LA. MENTAL HEALTH SYSTEM COMMUNITY HOMES DIVISION
Practice Location Address:

4502 HWY. 951
JACKSON, LA
70748-0498

Practice Phone: 225-634-0661
Practice Fax:

1790905545 — EASTERN LA. MENTAL HEALTH SYSTEM COMMUNITY HOMES DIVISION
Practice Location Address:

4502 HWY. 951
JACKSON, LA
70748-0498

Practice Phone: 225-634-0661
Practice Fax:

1790995124 — JACQUELINE MICHEL WHITMORE GSW
Practice Location Address:

4502 HWY.10
JACKSON, LA
70748-0498

Practice Phone: 225-634-0224
Practice Fax: 225-634-0213

1972130375 — SHELBY BUCKLEY MD
Practice Location Address:

PO BOX 498
JACKSON, LA
70748-0498

Practice Phone: 225-634-0100
Practice Fax:

1891796058 — JOSE KIAMCO MENDOZA JR. M.D.
Practice Location Address:

4502 HIGHWAY 951
JACKSON, LA
70748-5103

Practice Phone: 225-634-4820
Practice Fax: 225-634-0489

Directions to “ELMHS OUTPATIENT PHARMACY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.