# POINCIANA PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Poinciana Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811219827
- **Authorized official:** MR. ROBIN M DESHOTEL RPH (PIC)
- **Authorized official phone:** (337) 468-5001

## Contact information

- **Practice address:** 1508 CAJUN DR STE A, MAMOU, LA 70554-2400
- **Practice address phone:** (337) 468-5001
- **Practice address fax:** (337) 468-5102
- **Mailing address:** 1508 CAJUN DR, STE A, MAMOU, LA 70554-2400
- **Mailing address phone:** (337) 468-5001
- **Mailing address fax:** (337) 468-5102

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHY.006222-IR | LA | Yes |
| 3336L0003X | Long Term Care Pharmacy | PHY.006222-IR | LA | — |

## Other

- **Enumeration date:** 02/17/2010
- **Last updated:** 05/02/2025