Healthcare Provider Details

I. General information

NPI: 1124991674
Provider Name (Legal Business Name): KYRSTIN JANAE LASTRAPES RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CVS DR
WOONSOCKET RI
02895-6195
US

IV. Provider business mailing address

127 NAVAJO LN
OPELOUSAS LA
70570-0324
US

V. Phone/Fax

Practice location:
  • Phone: 800-746-7287
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.025984
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: