Active NPI
Brandon Eddlemon, RPH
- Pharmacist
- Monroe, LA
National Provider Identifier
1336711936
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PST.023931
- Practice address
- 2801 Louisville Ave
Monroe, LA 71201-6655 - Phone
- (318) 387-6023
- NPI assigned
- Jul 13, 2021
- Sex
- Male
- 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 | PST.023931 | LA | Primary |
Addresses
Primary practice location
2801 Louisville Ave
Monroe, LA 71201-6655
Mailing address
1102 Auburn Ave
Monroe, LA 71201-5406
Phone (318) 680-6188
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 |
|---|---|---|---|
| PST.023931 | LA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626134400000",
"number": "1336711936",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1102 AUBURN AVE",
"city": "MONROE",
"state": "LA",
"postal_code": "712015406",
"telephone_number": "318-680-6188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2801 LOUISVILLE AVE",
"city": "MONROE",
"state": "LA",
"postal_code": "712016655",
"telephone_number": "318-387-6023"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDDLEMON",
"first_name": "BRANDON",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-07-13",
"last_updated": "2021-07-13",
"certification_date": "2021-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "PST.023931",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monroe, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.