Active NPI
Travis Logan Eddlemon, R.PH
- Pharmacist
- Alexandria, LA
National Provider Identifier
1366085060
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 022807
- Practice address
- 3333 Masonic Dr
Alexandria, LA 71301-3842 - Phone
- (318) 623-6992
- NPI assigned
- Oct 25, 2019
- 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 | 022807 | LA | Primary |
Addresses
Primary practice location
3333 Masonic Dr
Alexandria, LA 71301-3842
Mailing address
3333 Masonic Dr
Alexandria, LA 71301-3842
Phone (318) 445-6386
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 |
|---|---|---|---|
| 022807 | 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": "1571961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571961600000",
"number": "1366085060",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3333 MASONIC DR",
"city": "ALEXANDRIA",
"state": "LA",
"postal_code": "713013842",
"telephone_number": "318-445-6386"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3333 MASONIC DR",
"city": "ALEXANDRIA",
"state": "LA",
"postal_code": "713013842",
"telephone_number": "318-623-6992"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDDLEMON",
"first_name": "TRAVIS",
"middle_name": "LOGAN",
"credential": "R.PH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-10-25",
"last_updated": "2019-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "022807",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alexandria, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.