Blakes Southside Pharmacy Phase II LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

BLAKES SOUTHSIDE PHARMACY PHASE II LLC

Practice address

808 S. Chataignier Rd
Ville Platte, LA 70586

Phone

(337) 363-7497

Fax

(337) 363-0473

NPI assigned

Feb 14, 2007

Organization subpart

No

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

Authorized official

Name

Mr. William L Foret, PHARMACIST

Title

Pic ( Pharmacist in Charge)

Phone

(337) 363-7497

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Blakes Southside Pharmacy INC Former legal business name

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599091200000",
    "number": "1164565933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 S. CHATAIGNIER RD",
            "city": "VILLE PLATTE",
            "state": "LA",
            "postal_code": "70586",
            "telephone_number": "337-363-7497",
            "fax_number": "337-363-0473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 S. CHATAIGNIER RD",
            "city": "VILLE PLATTE",
            "state": "LA",
            "postal_code": "70586",
            "telephone_number": "337-363-7497",
            "fax_number": "337-363-0473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLAKES SOUTHSIDE PHARMACY PHASE II LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A",
        "authorized_official_last_name": "FORET",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PIC ( PHARMACIST IN CHARGE)",
        "authorized_official_telephone_number": "337-363-7497",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARMACIST"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "LA",
            "license": "10232",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1252620",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blakes Southside Pharmacy INC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Alaina Bischoff, PHARMD
• Teri T Brown, PHD
• Ryan Jameson Buller, D.D.S.
• Hilda Marie Campbell
• Jacqueline Reed Cassidy, CRNA, NP
• Nikita Catoire

• Community/Retail Pharmacy in Ville Platte, LA
• Providers in Ville Platte, LA by specialty
• Community/Retail Pharmacy in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 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.