# DIAMONDHEAD HEALTH MART PHARMACY,LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pharmacy in Diamondhead, Diamondhead Health Mart Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003207895
- **Authorized official:** MR. RUDY ALLEN LETELLIER RPH (OWNER/PHARMACIST)
- **Authorized official phone:** (228) 222-4662

## Contact information

- **Practice address:** 4405 E ALOHA DR \# AA, DIAMONDHEAD, MS 39525-3380
- **Practice address phone:** (228) 222-4662
- **Practice address fax:** (228) 222-4733
- **Mailing address:** PO BOX 4258, BAY ST LOUIS, MS 39521-4258
- **Mailing address phone:** (228) 222-4662
- **Mailing address fax:** (228) 222-4733

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 14221/1.1 | MS | Yes |

## Other

- **Enumeration date:** 02/15/2015
- **Last updated:** 11/30/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 08129049 | — | MS |