Active NPI
Dwight Paul Thibodeaux, RPH
- Pharmacist
- Baton Rouge, LA
National Provider Identifier
1194129775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PST.016695
- Practice address
- 5551 Corporate Blvd
Suite 102
Baton Rouge, LA 70808-2567 - Phone
- (225) 924-1930
- Fax
- (225) 924-2620
- NPI assigned
- Oct 10, 2014
- 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 | PST.016695 | LA | Primary |
Addresses
Primary practice location
5551 Corporate Blvd
Suite 102
Baton Rouge, LA 70808-2567
Mailing address
36189 Norfolk Ave
Denham Springs, LA 70706-8587
Phone (225) 924-1930
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PST.016695 | LA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1412899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412899200000",
"number": "1194129775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36189 NORFOLK AVE",
"city": "DENHAM SPRINGS",
"state": "LA",
"postal_code": "707068587",
"telephone_number": "225-924-1930",
"fax_number": "225-924-2620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5551 CORPORATE BLVD",
"address_2": "SUITE 102",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708082567",
"telephone_number": "225-924-1930",
"fax_number": "225-924-2620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THIBODEAUX",
"first_name": "DWIGHT",
"middle_name": "PAUL",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-10-10",
"last_updated": "2014-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "PST.016695",
"primary": true
}
],
"identifiers": [],
"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 Oct 10, 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.