NPIMap

Individual provider Active NPI

Shannon Brasseaux, RPH.

  • Pharmacist
  • Gonzales, LA
National Provider Identifier
1245545482
Registry record updated Jan 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
16221 Issued in LA
Practice address
14639 Airline Hwy Ste 114
Gonzales, LA 70737-6632
Phone
(225) 070-4444
Fax
(225) 402-4088
NPI assigned
Aug 12, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 16221 LA Primary

Addresses

Primary practice location

14639 Airline Hwy Ste 114
Gonzales, LA 70737-6632

Mailing address

14639 Airline Hwy Ste 114
Gonzales, LA 70737-6632
Phone (254) 070-4442

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

LicenseStateTypeSpecialty
16221LAMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co Past Accepting new patients
Walgreen Co Past Accepting new patients
Lagniappe Pharmacy PastSince Jan 8, 2023 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1281571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672876800000",
    "number": "1245545482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14639 AIRLINE HWY STE 114",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707376632",
            "telephone_number": "254-070-4442",
            "fax_number": "225-402-4088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14639 AIRLINE HWY STE 114",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707376632",
            "telephone_number": "225-070-4444",
            "fax_number": "225-402-4088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRASSEAUX",
        "first_name": "SHANNON",
        "name_prefix": "Mr.",
        "credential": "RPH.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-12",
        "last_updated": "2023-01-05",
        "certification_date": "2023-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "LA",
            "license": "16221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gonzales, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2023; 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.