Active NPI
Michelle C Vaultz
- Pharmacist
- Baton Rouge, LA
National Provider Identifier
1194127654
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 20027
- Practice address
- 12881 Perkins Rd
Baton Rouge, LA 70810-1913 - Phone
- (225) 763-6281
- NPI assigned
- Sep 16, 2014
- Last updated
- Sep 16, 2014
- Sex
- Female
- 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 | 20027 | LA | Primary |
Addresses
Primary practice location
12881 Perkins Rd
Baton Rouge, LA 70810-1913
Mailing address
12881 Perkins Rd
Baton Rouge, LA 70810-1913
Phone (225) 763-6281
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20027 | Other | LA | IMMUNIZER |
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 |
|---|---|---|---|
| 20027 | LA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410825600000",
"number": "1194127654",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12881 PERKINS RD",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708101913",
"telephone_number": "225-763-6281"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12881 PERKINS RD",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708101913",
"telephone_number": "225-763-6281"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAULTZ",
"first_name": "MICHELLE",
"middle_name": "C",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-09-16",
"last_updated": "2014-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "20027",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IMMUNIZER",
"identifier": "20027",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Baton Rouge, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.