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General NPI Number Information
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NPI Number | 1154040335
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Entity Type | Individual
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Provider Name | DEREK DAIGLE DUFRENE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 4572 HIGHWAY 1
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City | RACELAND
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State | LA
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Zip | 70394-2772
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Country | US
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Telephone | 985-537-3296
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Fax |
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Provider Business Mailing Address
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Address Line | 159 GABRIEL ST
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City | HOUMA
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State | LA
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Zip | 70364-3823
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Country | US
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Telephone | 985-860-4992
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PST.024403
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License Number State | LA
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