Active NPI
Jessica Vidrine, PHARM.D.
- Pharmacist
- Denham Springs, LA
National Provider Identifier
1417264276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 19483
- Practice address
- 34865 La Highway 16
Denham Springs, LA 70706-0669 - Phone
- (225) 665-2428
- NPI assigned
- Aug 31, 2010
- Sex
- Female
- 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 | 19483 | LA | Primary |
Addresses
Primary practice location
34865 La Highway 16
Denham Springs, LA 70706-0669
Mailing address
29403 Greenwell Springs Rd
Greenwell Springs, LA 70739-6322
Phone (225) 603-1507
Other names 1
- Jessica Tate
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19483 | 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": "1283212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475107200000",
"number": "1417264276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29403 GREENWELL SPRINGS RD",
"city": "GREENWELL SPRINGS",
"state": "LA",
"postal_code": "707396322",
"telephone_number": "225-603-1507"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34865 LA HIGHWAY 16",
"city": "DENHAM SPRINGS",
"state": "LA",
"postal_code": "707060669",
"telephone_number": "225-665-2428"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIDRINE",
"first_name": "JESSICA",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-08-31",
"last_updated": "2016-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "19483",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JESSICA",
"last_name": "TATE",
"credential": "PHARM.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Denham Springs, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.