Healthcare Provider Details

I. General information

NPI: 1881240489
Provider Name (Legal Business Name): SHANNON CAUBARREAUX PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2019
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8585 PICARDY AVE
BATON ROUGE LA
70809-3748
US

IV. Provider business mailing address

17624 CHRISTOPHER CROSSING DR
BATON ROUGE LA
70817-7451
US

V. Phone/Fax

Practice location:
  • Phone: 225-763-4692
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.023102
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: