Provider Demographics
NPI:1336297381
Name:DELTA DRUGS OF PORT SULPHUR LLC
Entity type:Organization
Organization Name:DELTA DRUGS OF PORT SULPHUR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER/MGR
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:H
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:504-905-3196
Mailing Address - Street 1:866 MARLENE DR
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7642
Mailing Address - Country:US
Mailing Address - Phone:504-564-3141
Mailing Address - Fax:504-301-0773
Practice Address - Street 1:27136 HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:PORT SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70083-2648
Practice Address - Country:US
Practice Address - Phone:504-564-3141
Practice Address - Fax:504-301-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY005921IR3336C0003X, 3336C0003X
LA5921-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1253723Medicaid
LA1215759Medicaid
LA1253723Medicaid
LA1215759Medicaid