Organization
KAY'S HIDEAWAY PHARMACY, INC.
Active
Other names
Vital Care of Northeast LA
Organization subpart
No
Provider details
NPI number
Authorized official
KAY CHANDLER (OWNER)
(318) 343-4663
Entity
Organization
Contact information
Practice address
4140 OLD STERLINGTON RD, STE 3, MONROE, LA 71203-2629
(318) 343-4663
(317) 343-4691
Mailing address
4140 OLD STERLINGTON RD, MONROE, LA 71203-2629
(318) 343-4777
(318) 343-4691
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
3929 IR
LA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
3929 IR
LA
333600000X
Pharmacy
3929 IR
LA
3336C0003X
Community/Retail Pharmacy
3929-IR
LA
3336H0001X
Home Infusion Therapy Pharmacy
3929 IR
LA
3336L0003X
Long Term Care Pharmacy
3929-IR
LA
3336M0002X
Mail Order Pharmacy
3929-IR
LA
3336S0011X
Specialty Pharmacy
3929-IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265870
—
LA
Enumeration date
07/14/2006
Last updated
05/03/2022
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