Derel J Smith, P.D.

Primary specialty

PharmacistTaxonomy code 183500000X

License

14651 Issued in LA

Practice address

12125 Highway 90
Luling, LA 70070-3000

Phone

(985) 785-8772

Fax

(985) 785-8772

NPI assigned

Sep 12, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194829648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 BAYOU EST S",
            "city": "DES ALLEMANDS",
            "state": "LA",
            "postal_code": "700303342",
            "telephone_number": "985-758-2021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12125 HIGHWAY 90",
            "city": "LULING",
            "state": "LA",
            "postal_code": "700703000",
            "telephone_number": "985-785-8772",
            "fax_number": "985-785-8772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "DEREL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "P.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "LA",
            "license": "14651",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1266884",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Luling, LA
• Providers in Luling, LA by specialty
• Pharmacist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.