Samuel Aigbefoh
Individual provider Active NPI Pharmacist · Broussard, LA
NPI 1114397171 · NPPES record last updated Dec 23, 2020
Key facts
- NPI
- 1114397171
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 021289 (LA)
- Practice address
- 105 Saint Nazaire Rd
Broussard, LA 70518-4202 - Phone
- (337) 837-1640
- NPI assigned
- Oct 3, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021289 | LA | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jefferson Drug Pharmacy | Current | Accepting new patients | |
| Aigpharm LLC | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 021289 | LA | Yes |
Addresses
Primary practice location
105 Saint Nazaire Rd
Broussard, LA 70518-4202
Mailing address
1200 Robley Dr Apt 6304
Lafayette, LA 70503-5510
Other providers in Broussard, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 23, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.