Active NPI
Derek Fontenot
- Pharmacist
- Lake Charles, LA
National Provider Identifier
1609311927
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PST.021842
- Practice address
- 2011 Ryan St
Lake Charles, LA 70601-7313 - Phone
- (337) 508-3864
- NPI assigned
- Dec 21, 2016
- Last updated
- Dec 21, 2016
- 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.021842 | LA | Primary |
Addresses
Primary practice location
2011 Ryan St
Lake Charles, LA 70601-7313
Mailing address
1531 Country Club Rd Apt 511
Lake Charles, LA 70605-5343
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PST.021842 | Other | LA | LOUISIANA BOARD OF PHARMACY |
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 |
|---|---|---|---|
| PST.021842 | LA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1482278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1482278400000",
"number": "1609311927",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1531 COUNTRY CLUB RD APT 511",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706055343"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2011 RYAN ST",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706017313",
"telephone_number": "337-508-3864"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONTENOT",
"first_name": "DEREK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-12-21",
"last_updated": "2016-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "PST.021842",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LOUISIANA BOARD OF PHARMACY",
"identifier": "PST.021842",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Charles, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 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.