1336297381 NPI number — DELTA DRUGS OF PORT SULPHUR LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336297381 NPI number — DELTA DRUGS OF PORT SULPHUR LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELTA DRUGS OF PORT SULPHUR LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336297381
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
866 MARLENE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRETNA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70056-7642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-564-3141
Provider Business Mailing Address Fax Number:
504-301-0773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27136 HIGHWAY 23
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT SULPHUR
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70083-2648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-564-3141
Provider Business Practice Location Address Fax Number:
504-301-0773
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LE
Authorized Official First Name:
BROOKE
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PHARMACIST/OWNER/MGR
Authorized Official Telephone Number:
504-905-3196

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHY005921IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1253723 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1215759 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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