Ideal Health Mart Pharmacy Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

006477 Issued in LA

Legal business name

IDEAL HEALTH MART PHARMACY INC

Doing business as

ideal health mart

Practice address

610 N Pine St
Deridder, LA 70634-3546

Phone

(337) 463-7210

Fax

(337) 462-0930

NPI assigned

Jan 8, 2007

Last updated

May 16, 2014By 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

Kesa LaneNPI 1538475991

Title

RPH/Owner

Phone

(337) 463-7210

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• ideal health mart Doing business as

Medicare fee-for-service enrollment

Enrolled in LA

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.

• Kesa Lane, RPH

  • Pharmacist
  • Deridder, LA
  • NPI 1538475991
  NPD Authorized official

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400198400000",
    "number": "1568510030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 N PINE ST",
            "city": "DERIDDER",
            "state": "LA",
            "postal_code": "706343546",
            "telephone_number": "337-463-7210",
            "fax_number": "337-462-0930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 N PINE ST",
            "city": "DERIDDER",
            "state": "LA",
            "postal_code": "706343546",
            "telephone_number": "337-463-7210",
            "fax_number": "337-462-0930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL HEALTH MART PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2014-05-16",
        "status": "A",
        "authorized_official_last_name": "LANE",
        "authorized_official_first_name": "KESA",
        "authorized_official_title_or_position": "RPH/OWNER",
        "authorized_official_telephone_number": "337-463-7210"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "LA",
            "license": "006477",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2201344",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1902801",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ideal health mart",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hospital Service District No 2 of Parish of Beauregard State of la (Beauregard Memorial Hospital)
• Hospital Service District No 2 of Parish of Beauregard State of la (Beauregard Memorial Hospital)
• Hospital Service District No 2 of Parish of Beauregard State of la (Beauregard Medical and Surgical Center)
• Teresa Hunter, LMT
• Iberia Comprehensive Community Health Center, Inc. (DeRidder Community Health Center)
• Mark David Ifland, LPC, LMFT
• Casey L Iles, CLC
• Imperial Calcasieu Human Services Authority (ImCal BH Beauregard)
• Imperial Health LLP
• Imperial Health LLP

• Pharmacy in Deridder, LA
• Providers in Deridder, LA by specialty
• Pharmacy in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2014; 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.