Active NPI
Wylie Lee Shores, R.PH.
- Pharmacist
- Shreveport, LA
National Provider Identifier
1245548098
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 13028
- Practice address
- 745 Shreveport Barksdale Hwy
Shreveport, LA 71105-2201 - Phone
- (318) 861-3985
- NPI assigned
- Sep 15, 2010
- Last updated
- Sep 15, 2010
- Sex
- Male
- Sole proprietor
- No
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 | 13028 | LA | Primary |
Addresses
Primary practice location
745 Shreveport Barksdale Hwy
Shreveport, LA 71105-2201
Mailing address
6145 Ripplewood Dr
Shreveport, LA 71107-9586
Phone (318) 518-0359
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13028 | Other | LA | PHARMACY LICENSE |
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 |
|---|---|---|---|
| 13028 | LA | MD | Case Manager/Care Coordinator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1284508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1284508800000",
"number": "1245548098",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6145 RIPPLEWOOD DR",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711079586",
"telephone_number": "318-518-0359"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "745 SHREVEPORT BARKSDALE HWY",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711052201",
"telephone_number": "318-861-3985"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHORES",
"first_name": "WYLIE",
"middle_name": "LEE",
"credential": "R.PH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-09-15",
"last_updated": "2010-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "13028",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACY LICENSE",
"identifier": "13028",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.