Provider Demographics
NPI:1700891348
Name:HEALTH MART PHARMACY OF JENNINGS L L C
Entity Type:Organization
Organization Name:HEALTH MART PHARMACY OF JENNINGS L L C
Other - Org Name:HEALTH MART PHARMACY OF JENNINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:337-523-1851
Mailing Address - Street 1:1322 ELTON RD
Mailing Address - Street 2:STE A
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-4138
Mailing Address - Country:US
Mailing Address - Phone:337-616-9500
Mailing Address - Fax:337-616-9555
Practice Address - Street 1:1322 ELTON RD
Practice Address - Street 2:STE A
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-4138
Practice Address - Country:US
Practice Address - Phone:337-616-9500
Practice Address - Fax:337-616-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAC005639IR333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1932804OtherOTHER ID NUMBER-COMMERCIAL NUMBER