Provider Demographics
NPI:1518395755
Name:HAYDELS DRUG STORE #3
Entity Type:Organization
Organization Name:HAYDELS DRUG STORE #3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ROCK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:985-879-2440
Mailing Address - Street 1:4752 HWY 311
Mailing Address - Street 2:SUITE #100
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360
Mailing Address - Country:US
Mailing Address - Phone:985-879-2440
Mailing Address - Fax:985-879-2967
Practice Address - Street 1:4752 HIGHWAY 311
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2810
Practice Address - Country:US
Practice Address - Phone:985-879-2440
Practice Address - Fax:985-879-2967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-25
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA105823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy