Provider Demographics
NPI:1306712294
Name:HAYDELS DRUG STORE ST CHARLES
Entity type:Organization
Organization Name:HAYDELS DRUG STORE ST CHARLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-PRESIDENT
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:985-219-7979
Mailing Address - Street 1:1297 SAINT CHARLES ST STE E
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2869
Mailing Address - Country:US
Mailing Address - Phone:985-219-7979
Mailing Address - Fax:985-879-2967
Practice Address - Street 1:1297 SAINT CHARLES ST STE E
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2869
Practice Address - Country:US
Practice Address - Phone:985-219-7979
Practice Address - Fax:985-879-2967
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAYDELS DRUG STORE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy