Active NPI
Connie Stackhouse
- Pharmacist
- Lake Charles, LA
National Provider Identifier
1295096493
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 14020
- Practice address
- 4828 Nelson Rd
Lake Charles, LA 70605-5214 - Phone
- (337) 477-9068
- NPI assigned
- Jun 4, 2012
- Last updated
- Jun 4, 2012
- Sex
- Female
- 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 | 14020 | LA | Primary |
Addresses
Primary practice location
4828 Nelson Rd
Lake Charles, LA 70605-5214
Mailing address
2001 Plantation Dr
Lake Charles, LA 70605-5266
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14020 | LA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Louisiana CVS Pharmacy, L.L.C. | Past | Accepting new patients | |
| Louisiana CVS Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
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": []
}Other providers in Lake Charles, LA
- 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 (Sensible Dental)
Sources for this page
- 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.