Provider Demographics
NPI:1497840474
Name:KASTAK SERVICES, L.L.C.
Entity type:Organization
Organization Name:KASTAK SERVICES, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:337-332-5010
Mailing Address - Street 1:1456 E BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-3406
Mailing Address - Country:US
Mailing Address - Phone:337-332-5010
Mailing Address - Fax:337-332-6068
Practice Address - Street 1:1456 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-3406
Practice Address - Country:US
Practice Address - Phone:337-332-5010
Practice Address - Fax:337-332-6068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1269646Medicaid
1930785OtherNCPDP
LA4636500001Medicare NSC