Active NPI
Bryson Cole Bertrand
- Pharmacist
- Jennings, LA
National Provider Identifier
1891242103
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 021723
- Practice address
- 1322 Elton Rd Ste M
Jennings, LA 70546-4100 - Phone
- (337) 246-3946
- NPI assigned
- Sep 2, 2016
- Last updated
- Jul 14, 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 | 021723 | LA | Primary |
Addresses
Primary practice location
1322 Elton Rd Ste M
Jennings, LA 70546-4100
Mailing address
1322 Elton Rd
Jennings, LA 70546-4100
Other practice location 1
366 Sam Houston Jones Pkwy
Lake Charles, LA 70611-5602
Phone (337) 855-1341
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 |
|---|---|---|---|
| 021723 | LA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Louisiana CVS Pharmacy, L.L.C. | Past | Accepting new patients | |
| CVS/Caremark | 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.
-
- Community/Retail Pharmacy
- Lake Charles, LA
- NPI 1205235744
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594684800000",
"number": "1891242103",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1322 ELTON RD",
"city": "JENNINGS",
"state": "LA",
"postal_code": "705464100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1322 ELTON RD STE M",
"city": "JENNINGS",
"state": "LA",
"postal_code": "705464100",
"telephone_number": "337-246-3946"
}
],
"practiceLocations": [
{
"address_1": "366 Sam Houston Jones Pkwy",
"address_purpose": "LOCATION",
"city": "Lake Charles",
"state": "LA",
"postal_code": "706115602",
"country_code": "US",
"telephone_number": "337-855-1341",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BERTRAND",
"first_name": "BRYSON",
"middle_name": "COLE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-09-02",
"last_updated": "2020-07-14",
"certification_date": "2020-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "021723",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jennings, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 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.