Active NPI
Shane P Primeaux, RPH
- Pharmacist
- Lafayette, LA
National Provider Identifier
1689923849
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PST.015957
- Practice address
- 4811 Ambassador Caffery Pkwy Ste 101
Lafayette, LA 70508-7266 - Phone
- (337) 806-9000
- Fax
- (337) 806-9074
- NPI assigned
- Sep 4, 2012
- Last updated
- Dec 3, 2020
- 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 | PST.015957 | LA | Primary |
Addresses
Primary practice location
4811 Ambassador Caffery Pkwy Ste 101
Lafayette, LA 70508-7266
Mailing address
4811 Ambassador Caffery Pkwy Ste 101
Lafayette, LA 70508-7266
Phone (337) 806-9000
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.015957 | LA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Park Pharmacy LLC | Current | Accepting new patients | |
| Park Pharmacy LLC | Current | Accepting new patients |
Locations
4811 Ambassador Caffery Pkwy
Ste 101
Lafayette, LA 70508
Phone (337) 806-9000
Organizations & group practices 4
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.
-
- Long Term Care Pharmacy
- Lafayette, LA
- NPI 1073109633
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606953600000",
"number": "1689923849",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4811 AMBASSADOR CAFFERY PKWY STE 101",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705087266",
"telephone_number": "337-806-9000",
"fax_number": "337-806-9074"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4811 AMBASSADOR CAFFERY PKWY STE 101",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705087266",
"telephone_number": "337-806-9000",
"fax_number": "337-806-9074"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRIMEAUX",
"first_name": "SHANE",
"middle_name": "P",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-09-04",
"last_updated": "2020-12-03",
"certification_date": "2020-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "PST.015957",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.