Vidrine Pharmaceutical Group, LLC

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

Legal business name

VIDRINE PHARMACEUTICAL GROUP, LLC

Practice address

404 E Prien Lake Rd
Lake Charles, LA 70601-8507

Phone

(337) 436-7216

NPI assigned

Jul 13, 2020

Organization subpart

Yes

Parent organization

VIDRINE PHARMACEUTICAL GROUP, LLCAs reported in NPPES

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

Authorized official

Name

Mr. Jesse Vidrine

Title

Owner

Phone

(337) 436-7216

Specialties & licenses 1

Addresses

Other names 1

• Boudreaux's New Drug Store Doing business as

Part of

Vidrine Pharm Group LLC

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

{
    "created_epoch": "1594598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594944000000",
    "number": "1043838469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 E PRIEN LAKE RD",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706018507",
            "telephone_number": "337-436-7216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 E PRIEN LAKE RD",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706018507",
            "telephone_number": "337-436-7216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIDRINE PHARMACEUTICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VIDRINE PHARMACEUTICAL GROUP, LLC",
        "enumeration_date": "2020-07-13",
        "last_updated": "2020-07-17",
        "certification_date": "2020-07-17",
        "status": "A",
        "authorized_official_last_name": "VIDRINE",
        "authorized_official_first_name": "JESSE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "337-436-7216",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boudreaux's New Drug Store",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Austin Verrett, PHARMD
• Lori Lyn Verzwyvelt, RPH
• Lindsay Viator
• Gerard M. Victoriano Jr., PA
• Victory Transportation
• Kimberly Ann Vidrine, M.S., CCC-SLP
• Pamela Kay Vidrine
• Sandra Isabel Viggiani, PHD
• Shantel Viltz
• Hallie L. Vincent

• Compounding Pharmacy in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Compounding Pharmacy in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2020; 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.