Active NPI
Robert Nethery
- Pharmacist
- Ponchatoula, LA
National Provider Identifier
1083020838
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 160048
- Practice address
- 1100 W Pine St
Ponchatoula, LA 70454-3700 - Phone
- (985) 386-2421
- Fax
- (985) 386-5988
- NPI assigned
- Jul 1, 2014
- Last updated
- Dec 27, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 160048 | LA | Primary |
Addresses
Primary practice location
1100 W Pine St
Ponchatoula, LA 70454-3700
Mailing address
1100 W Pine St
Ponchatoula, LA 70454-3700
Phone (985) 386-2421
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160048 | LA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Manninos Family Practice Pharmacy Inc | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Manninos Family Practice Pharmacy Inc | Past | Accepting new patients |
Locations
1100 W Pine St
Ponchatoula, LA 70454
Phone (985) 386-2421
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Mannino's Pharmacy LTC
- Long Term Care Pharmacy
- Hammond, LA
- NPI 1013648674
-
dba Mannino's Family Practice Pharmacy
- Community/Retail Pharmacy
- Hammond, LA
- NPI 1891700431
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404172800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672099200000",
"number": "1083020838",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 W PINE ST",
"city": "PONCHATOULA",
"state": "LA",
"postal_code": "704543700",
"telephone_number": "985-386-2421",
"fax_number": "985-386-5988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 W PINE ST",
"city": "PONCHATOULA",
"state": "LA",
"postal_code": "704543700",
"telephone_number": "985-386-2421",
"fax_number": "985-386-5988"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NETHERY",
"first_name": "ROBERT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-07-01",
"last_updated": "2022-12-27",
"certification_date": "2022-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "160048",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ponchatoula, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 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.