Organization
DIAMONDHEAD HEALTH MART PHARMACY,LLC
Active
Other names
Pharmacy in Diamondhead, Diamondhead Health Mart Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUDY ALLEN LETELLIER RPH (OWNER/PHARMACIST)
(228) 222-4662
Entity
Organization
Contact information
Practice address
4405 E ALOHA DR # AA, DIAMONDHEAD, MS 39525-3380
(228) 222-4662
(228) 222-4733
Mailing address
PO BOX 4258, BAY ST LOUIS, MS 39521-4258
(228) 222-4662
(228) 222-4733
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
14221/1.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08129049
—
MS
Enumeration date
02/15/2015
Last updated
11/30/2021
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