Fred's Pharmacy #3958

Primary specialty

PharmacistTaxonomy code 183500000X

License

PST.018472 Issued in LA

Legal business name

FRED'S PHARMACY #3958

Practice address

303 N Hood St
Lake Providence, LA 71254-2141

Phone

(318) 559-2433

Fax

(318) 559-2437

NPI assigned

Sep 14, 2015

Last updated

Sep 14, 2015By 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

Laura Perkins

Title

Pharmacist

Phone

(318) 559-2433

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1442188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442188800000",
    "number": "1043688658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 N HOOD ST",
            "city": "LAKE PROVIDENCE",
            "state": "LA",
            "postal_code": "712542141",
            "telephone_number": "318-559-2433",
            "fax_number": "318-559-2437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 N HOOD ST",
            "city": "LAKE PROVIDENCE",
            "state": "LA",
            "postal_code": "712542141",
            "telephone_number": "318-559-2433",
            "fax_number": "318-559-2437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRED'S PHARMACY #3958",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-14",
        "last_updated": "2015-09-14",
        "status": "A",
        "authorized_official_last_name": "PERKINS",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "318-559-2433"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MS",
            "license": "E-010467",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "LA",
            "license": "PST.018472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kanitra Elmore
• George Fakhre
• Ann Sullivan Fautheree, LPC
• Sade' Finley
• Savannah Fortenberry, APRN, FNP-C
• Freds Stores of Tennessee Inc. (Freds Pharmacy 3958)
• Catina Freeman
• Heather George, BA
• Sharolyn Gibson
• Tonya Denise Gordon

• Pharmacist in Lake Providence, LA
• Providers in Lake Providence, LA by specialty
• Pharmacist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2015; 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.