Search Icon


Provider Type Icon

DIAMONDHEAD HEALTH MART PHARMACYLLC NPI 1003207895


NPI Information

NPI: 1003207895
Provider Name: DIAMONDHEAD HEALTH MART PHARMACY,LLC

Doing Business As: PHARMACY IN DIAMONDHEAD

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

CLIA Number: 25D2215717

Address:
4405 E ALOHA DR # AA
DIAMONDHEAD, MS
ZIP 39525
Phone: (228) 222-4662
Get Directions

DIAMONDHEAD HEALTH MART PHARMACY,LLC is a community/retail pharmacy pharmacy in Diamondhead, MS. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. DIAMONDHEAD HEALTH MART PHARMACY,LLC NPI is 1003207895. The provider is registered as an organization entity type.
The provider Is Doing Business As Pharmacy In Diamondhead.

The provider's business location address is:

4405 E ALOHA DR # AA
DIAMONDHEAD, MS
ZIP 39525-380
Phone: (228) 222-4662
Fax: (228) 222-4733

The provider's authorized official is Rudy Allen Letellier .
The authorized official title is Owner/pharmacist and has the following contact phone number (228) 222-4662.

The CLIA number assigned to this NPI record is 25D2215717 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/15/2015 and was last updated on 11/30/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
13336C0003XPharmacyCommunity/Retail Pharmacy14221/1.1MISSISSIPPIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
108129049MEDICAIDMISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/15/2022

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.