Individual provider Active NPI

Lauren Rebecca Roach, PHARM D

  • Pharmacist
  • Wynne, AR
National Provider Identifier
1013353366
Registry record updated Jun 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PD11305 Issued in AR
Practice address
804 Falls Blvd S
Wynne, AR 72396-3505
Phone
(870) 238-7085
Fax
(870) 238-8937
NPI assigned
May 14, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PD11305 AR Primary

Addresses

Primary practice location

804 Falls Blvd S
Wynne, AR 72396-3505

Mailing address

804 Falls Blvd S
Wynne, AR 72396-3505
Phone (870) 238-7085

Other names 1

  • Dr. Lauren Rebecca St.Jean Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
PD11305ARMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1368489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403654400000",
    "number": "1013353366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 FALLS BLVD S",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723963505",
            "telephone_number": "870-238-7085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 FALLS BLVD S",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723963505",
            "telephone_number": "870-238-7085",
            "fax_number": "870-238-8937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROACH",
        "first_name": "LAUREN",
        "middle_name": "REBECCA",
        "name_prefix": "Dr.",
        "credential": "PHARM D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-14",
        "last_updated": "2014-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AR",
            "license": "PD11305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAUREN",
            "last_name": "ST.JEAN",
            "middle_name": "REBECCA",
            "prefix": "DR.",
            "credential": "PHARM D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Wynne, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2014; 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.