Organization
PONTCHARTRAIN PHARMACY, LLC
Active
Organization
PONTCHARTRAIN PHARMACY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY LYNN LEACH CPA (CHIEF FINANCIAL OFFICER)
(985) 626-1900
Entity
Organization
Contact information
Practice address
2045 HIGHWAY 59, MANDEVILLE, LA 70448-1909
(985) 626-9726
(985) 626-7919
Mailing address
PO BOX 399, MANDEVILLE, LA 70470-0399
(985) 626-9726
(985) 626-7919
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
1270-IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1234460
—
LA
Enumeration date
09/29/2005
Last updated
03/16/2021
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