Organization
POINCIANA PHARMACY LLC
Active
Other names
Poinciana Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBIN M DESHOTEL RPH (PIC)
(337) 468-5001
Entity
Organization
Contact information
Practice address
1508 CAJUN DR STE A, MAMOU, LA 70554-2400
(337) 468-5001
(337) 468-5102
Mailing address
1508 CAJUN DR, STE A, MAMOU, LA 70554-2400
(337) 468-5001
(337) 468-5102
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY.006222-IR
LA
3336L0003X
Long Term Care Pharmacy
PHY.006222-IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235598
—
LA
01
—
2123858
PK
—
Enumeration date
02/17/2010
Last updated
05/02/2025
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