Poinciana Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY.006222-IR Issued in LA

Legal business name

POINCIANA PHARMACY LLC

Doing business as

Poinciana Pharmacy

Practice address

1508 Cajun Dr Ste a
Mamou, LA 70554-2400

Phone

(337) 468-5001

Fax

(337) 468-5102

NPI assigned

Feb 17, 2010

Last updated

May 2, 2025By 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. Robin M Deshotel, RPHNPI 1992326763

Title

Pic

Phone

(337) 468-5001

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Poinciana Pharmacy Doing business as

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.

• Robin Mark Deshotel, RPH

  • Pharmacist
  • Mamou, LA
  • NPI 1992326763
  Authorized official Same address or phone

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

{
    "created_epoch": "1266364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746144000000",
    "number": "1811219827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1508 CAJUN DR",
            "address_2": "STE A",
            "city": "MAMOU",
            "state": "LA",
            "postal_code": "705542400",
            "telephone_number": "337-468-5001",
            "fax_number": "337-468-5102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1508 CAJUN DR STE A",
            "city": "MAMOU",
            "state": "LA",
            "postal_code": "705542400",
            "telephone_number": "337-468-5001",
            "fax_number": "337-468-5102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POINCIANA PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-17",
        "last_updated": "2025-05-02",
        "certification_date": "2025-05-02",
        "status": "A",
        "authorized_official_last_name": "DESHOTEL",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "337-468-5001",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "LA",
            "license": "PHY.006222-IR",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "LA",
            "license": "PHY.006222-IR",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2123858",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235598",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Poinciana Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Juanita Golemon Moorman, MSW
• Theodore A Pappas
• Kenneth Scott Parks, MD
• Philip Paulk, MD
• Poinciana Clinic Pharmacy
• Michael J Prejean, MD PSYCHIATRIST
• Prentiss a. Perkins, D.D.S.
• Rapides Healthcare System LLC
• Rapides Healthcare System, L.L.C. (Savoy Family Hospice)
• Rapides Healthcare System, L.L.C. (Savoy Medical Center)

• Community/Retail Pharmacy in Mamou, LA
• Providers in Mamou, LA by specialty
• Community/Retail Pharmacy in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.