Provider Demographics
NPI:1083889018
Name:KASTAK SERVICES, L.L.C.
Entity Type:Organization
Organization Name:KASTAK SERVICES, L.L.C.
Other - Org Name:RALPH'S PHARMACY #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMONEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:225-214-0133
Mailing Address - Street 1:6576 JONES CREEK RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-3023
Mailing Address - Country:US
Mailing Address - Phone:225-214-0133
Mailing Address - Fax:225-214-0136
Practice Address - Street 1:6576 JONES CREEK RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-3023
Practice Address - Country:US
Practice Address - Phone:225-214-0133
Practice Address - Fax:225-214-0136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.007109-IR333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151721OtherPK