Diamondhead Health Mart Pharmacy,LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

14221/1.1 Issued in MS

Legal business name

DIAMONDHEAD HEALTH MART PHARMACY,LLC

Doing business as

Diamondhead Health Mart Pharmacy
Pharmacy in Diamondhead

Practice address

4405 E Aloha Dr # Aa
Diamondhead, MS 39525-3380

Phone

(228) 222-4662

Fax

(228) 222-4733

NPI assigned

Feb 15, 2015

Last updated

Nov 30, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Rudy Allen Letellier, RPHNPI 1477143691

Title

Owner/Pharmacist

Phone

(228) 222-4662

Specialties & licenses 1

Addresses

Other names 2

• Diamondhead Health Mart Pharmacy Doing business as
• Pharmacy in Diamondhead Doing business as

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rudy Letellier

  • Pharmacist
  • Waveland, MS
  • NPI 1477143691
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1423958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638230400000",
    "number": "1003207895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4258",
            "city": "BAY ST LOUIS",
            "state": "MS",
            "postal_code": "395214258",
            "telephone_number": "228-222-4662",
            "fax_number": "228-222-4733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4405 E ALOHA DR # AA",
            "city": "DIAMONDHEAD",
            "state": "MS",
            "postal_code": "395253380",
            "telephone_number": "228-222-4662",
            "fax_number": "228-222-4733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAMONDHEAD HEALTH MART PHARMACY,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-15",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A",
        "authorized_official_last_name": "LETELLIER",
        "authorized_official_first_name": "RUDY",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "OWNER/PHARMACIST",
        "authorized_official_telephone_number": "228-222-4662",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "14221/1.1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diamondhead Health Mart Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pharmacy in Diamondhead",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• D and F Inc (Hoda Chiropractic Clinic)
• Thanh Dang
• David F. Roberts, MD
• Abigail Dearman
• Erin Adam Dewitt, M.D.
• Diamondhead Medicine, LLC (Diamondhead Family Pharmacy)
• Diamondhead Pharmacy & Gifts, Inc
• Diamondhead Urgent Care
• Tracy Rene Diercks, DPT, PT
• Duncan F Matheson III DDS PA

• Community/Retail Pharmacy in Diamondhead, MS
• Providers in Diamondhead, MS by specialty
• Community/Retail Pharmacy in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.