MEDICARE: DELTA DRUGS OF PORT SULPHUR LLC

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	PHY005921IR	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336297381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELTA DRUGS OF PORT SULPHUR LLC

Provider Business Mailing Address
First Line	:	866 MARLENE DR
Second Line	:
City	:	GRETNA
State	:	LA
Zip	:	70056-7642
Country	:	US
Telephone Number	:	504-564-3141
Fax Number	:	504-301-0773

Provider Business Practice Location Address
First Line	:	27136 HIGHWAY 23
Second Line	:
City	:	PORT SULPHUR
State	:	LA
Zip	:	70083-2648
Country	:	US
Telephone Number	:	504-564-3141
Fax Number	:	504-301-0773

Authorized Official
Title or Position	:	PHARMACIST/OWNER/MGR
Name	:	BROOKE H LE
Credential	:	RPH
Telephone Number	:	504-905-3196

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	05/06/2025

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