Lake Area Pharmacy

Primary specialty

PharmacyTaxonomy code 333600000X

License

5129-IR Issued in LA

Legal business name

LAKE AREA PHARMACY

Practice address

1004 Fortune Rd Ste 6
Youngsville, LA 70592-5793

Phone

(337) 450-3052

Fax

(337) 450-3053

NPI assigned

Dec 11, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Brian Scott Cloud, RPH

Title

Director of Pharmacy

Phone

(337) 721-1931

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662681600000",
    "number": "1003976028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1004 FORTUNE RD STE 6",
            "city": "YOUNGSVILLE",
            "state": "LA",
            "postal_code": "705925793",
            "telephone_number": "337-450-3052",
            "fax_number": "337-450-3053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 FORTUNE RD STE 6",
            "city": "YOUNGSVILLE",
            "state": "LA",
            "postal_code": "705925793",
            "telephone_number": "337-450-3052",
            "fax_number": "337-450-3053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE AREA PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2022-09-09",
        "certification_date": "2022-09-09",
        "status": "A",
        "authorized_official_last_name": "CLOUD",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "337-721-1931",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "LA",
            "license": "5129-IR",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1271080",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2022; 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.