Healthcare Provider Details

I. General information

NPI: 1578152013
Provider Name (Legal Business Name): CHRISTIAN WAITE CARNES PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 N FRANKLIN ST
BASTROP LA
71220-3846
US

IV. Provider business mailing address

PO BOX 792
BASTROP LA
71221-0792
US

V. Phone/Fax

Practice location:
  • Phone: 318-283-8887
  • Fax: 318-281-6339
Mailing address:
  • Phone: 318-283-8887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number023540
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPST.023540
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: