MEDICARE: HAI YEN PHARMACY 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	6042	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1934074	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1548418916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAI YEN PHARMACY LLC

Provider Business Mailing Address
First Line	:	4601 ALCEE FORTIER BLVD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70129-2140
Country	:	US
Telephone Number	:	504-324-6310
Fax Number	:	504-254-3928

Provider Business Practice Location Address
First Line	:	4601 ALCEE FORTIER BLVD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70129-2140
Country	:	US
Telephone Number	:	504-324-6310
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HAIYEN NGUYEN
Credential	:
Telephone Number	:	540-473-1825

Provider Enumeration Date	:	08/28/2008
Last Update Date	:	12/14/2010

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Directions to “HAI YEN PHARMACY LLC ” Practice Location

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