Eddie's Pharmacy, Inc.

Primary specialty

PharmacyTaxonomy code 333600000X

License

1692-IR Issued in LA

Legal business name

EDDIE'S PHARMACY, INC.

Practice address

206 Choupique LN
Cottonport, LA 71327-3757

Phone

(318) 876-3665

Fax

(318) 876-3665

NPI assigned

Nov 1, 2005

Last updated

Mar 7, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Roland Eddie Bordelon, R.PH.

Title

President/Owner/Chief Pharmacist

Phone

(318) 876-3665

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kimberly Dupuy Wixson

  • Pharmacist
  • Cottonport, LA
  • NPI 1528468808
  NPD (past)

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

{
    "created_epoch": "1130803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1306837141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 CHOUPIQUE LN",
            "city": "COTTONPORT",
            "state": "LA",
            "postal_code": "713273757",
            "telephone_number": "318-876-3665",
            "fax_number": "318-876-3665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 CHOUPIQUE LN",
            "city": "COTTONPORT",
            "state": "LA",
            "postal_code": "713273757",
            "telephone_number": "318-876-3665",
            "fax_number": "318-876-3665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDDIE'S PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-01",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "BORDELON",
        "authorized_official_first_name": "ROLAND",
        "authorized_official_middle_name": "EDDIE",
        "authorized_official_title_or_position": "PRESIDENT/OWNER/CHIEF PHARMACIST",
        "authorized_official_telephone_number": "318-876-3665",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "LA",
            "license": "1692-IR",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1253626",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "1919337",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristen Bordelon Jeansonne, NURSE PRACTITIONER
• Dustin Borrel, LMSW
• Jeanne Cancienne, SOCIAL WORKER, LMSW
• CLHG-Avoyelles LLC (Cottonport Family Care Center)
• Cottonport Corner Drug LLC
• Kendell Rachel Fisher, FNP-C
• Galrob, Inc. (Personalized Care of Avoyelles)
• Galrob, Inc. (Personalized Care of Avoyelles RHC)
• Jamie Garrett, NP
• Chad Paul Gauthier, APRN

• Pharmacy in Cottonport, LA
• Providers in Cottonport, LA by specialty
• Pharmacy in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.