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NPI Code Detail

MEDICARE: DEREK LEGENDRE PHARMD

MEDICARE: DEREK LEGENDRE PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist18277LA

General Provider Information

NPI Number : 1700191707
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEREK LEGENDRE PHARMD
Provider Business Mailing Address
First Line : 3320 COPPERWOOD DR
Second Line :
City : GRAY
State : LA
Zip : 70359-5328
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1415 SAINT CHARLES ST
Second Line :
City : HOUMA
State : LA
Zip : 70360-3964
Country : US
Telephone Number : 985-868-4033
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2010
Last Update Date : 08/13/2010

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Directions to “ DEREK LEGENDRE PHARMD” Practice Location

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