Provider Demographics
NPI:1669871638
Name:HAYDELS DRUG STORE #1
Entity type:Organization
Organization Name:HAYDELS DRUG STORE #1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:985-860-7870
Mailing Address - Street 1:300 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4510
Mailing Address - Country:US
Mailing Address - Phone:985-872-5201
Mailing Address - Fax:985-872-5525
Practice Address - Street 1:300 CHURCH ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4510
Practice Address - Country:US
Practice Address - Phone:985-872-5201
Practice Address - Fax:985-872-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0120193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy