Connie Stackhouse

Primary specialty

PharmacistTaxonomy code 183500000X

License

14020 Issued in LA

Practice address

4828 Nelson Rd
Lake Charles, LA 70605-5214

Phone

(337) 477-9068

NPI assigned

Jun 4, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Louisiana CVS Pharmacy LLC

  • Pharmacy
  • Mandeville, LA
  • NPI 1619695848
  NPD (past)
• Louisiana CVS Pharmacy, L.L.C.

  • Pharmacy
  • Lake Charles, LA
  • NPI 1487720314
  NPD (past)

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

{
    "created_epoch": "1338768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338768000000",
    "number": "1295096493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 PLANTATION DR",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706055266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4828 NELSON RD",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706055214",
            "telephone_number": "337-477-9068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACKHOUSE",
        "first_name": "CONNIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-04",
        "last_updated": "2012-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "LA",
            "license": "14020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• St. Luke'S Diagnostic Clinic of Lake Charles, L.L.C.
• St. Nicholas Center for Children
• St. Paul Companion Care, L.L.C.
• Bethany St. Romain, APRN, FNP-C
• Christian B St. Romain, DDS
• Kaycie Stacy
• Earl Ray Stagg, M.D.
• Stanley R Kordisch M D AMC
• Star Care Service Inc
• Starfish Lake Charles

• Pharmacist in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Pharmacist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2012; 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.