Active NPI
Aubrey Booth Wynn III, RPH MBA MHA
- Pharmacist
- Shreveport, LA
National Provider Identifier
1144569609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 14260
- Practice address
- 9250 Mansfield Rd
Shreveport, LA 71118-3125 - Phone
- (318) 686-6311
- Fax
- (318) 686-3999
- NPI assigned
- Feb 4, 2013
- 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 | 14260 | LA | Primary |
Addresses
Primary practice location
9250 Mansfield Rd
Shreveport, LA 71118-3125
Mailing address
9250 Mansfield Rd
Shreveport, LA 71118-3125
Phone (318) 686-6311
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
- Master of Business Administration, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14260 | LA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1359936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359936000000",
"number": "1144569609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9250 MANSFIELD RD",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711183125",
"telephone_number": "318-686-6311",
"fax_number": "318-686-3999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9250 MANSFIELD RD",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711183125",
"telephone_number": "318-686-6311",
"fax_number": "318-686-3999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYNN",
"first_name": "AUBREY",
"middle_name": "BOOTH",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "RPH MBA MHA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-02-04",
"last_updated": "2013-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "14260",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.