Derek Daigle Dufrene, PHARMD
Individual provider Active NPI Pharmacist · Raceland, LA
NPI 1154040335 · NPPES record last updated Aug 23, 2022
Key facts
- NPI
- 1154040335
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PST.024403 (LA)
- Practice address
- 4572 Highway 1
Raceland, LA 70394-2772 - Phone
- (985) 537-3296
- NPI assigned
- Aug 23, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PST.024403 | LA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Louisiana CVS Pharmacy, L.L.C. | Past |
Accepting new patients | |
| Louisiana CVS Pharmacy LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PST.024403 | LA | Yes |
Addresses
Primary practice location
4572 Highway 1
Raceland, LA 70394-2772
Mailing address
159 Gabriel St
Houma, LA 70364-3823
Phone (985) 860-4992
Other practice location 1
602 N Acadia Rd
Thibodaux, LA 70301-4823
Phone (985) 493-4545
Other providers in Raceland, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 23, 2022. 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.