Active NPI
Whitney Prudhomme
- Pharmacist
- Jena, LA
National Provider Identifier
1619425626
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PST.021739
- Practice address
- 3670 W Oak St
Jena, LA 71342-4474 - Phone
- (318) 992-1357
- NPI assigned
- Sep 19, 2016
- Last updated
- Sep 19, 2016
- Sex
- Female
- 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.021739 | LA | Primary |
Addresses
Primary practice location
3670 W Oak St
Jena, LA 71342-4474
Mailing address
3670 W Oak St
Jena, LA 71342-4474
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PST.021739 | Other | 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.021739 | LA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Mart Stores East LP | Past | Accepting new patients | |
| Wal-Mart Stores East, LP | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Walmart Pharmacy 10-0498
- Community/Retail Pharmacy
- Jena, LA
- NPI 1346267614
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1474243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474243200000",
"number": "1619425626",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3670 W OAK ST",
"city": "JENA",
"state": "LA",
"postal_code": "713424474"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3670 W OAK ST",
"city": "JENA",
"state": "LA",
"postal_code": "713424474",
"telephone_number": "318-992-1357"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRUDHOMME",
"first_name": "WHITNEY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-09-19",
"last_updated": "2016-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "PST.021739",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACY",
"identifier": "PST.021739",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Jena, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 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.