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NPI Code Detail

MEDICARE: WHITNEY PRUDHOMME

MEDICARE: WHITNEY PRUDHOMME
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
1183500000XPharmacistPST.021739LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PST.021739OTHERPHARMACY

General Provider Information

NPI Number : 1619425626
Entity Type Code : Individual
Provider Name (Legal Business Name) : WHITNEY PRUDHOMME
Provider Business Mailing Address
First Line : 3670 W OAK ST
Second Line :
City : JENA
State : LA
Zip : 71342-4474
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3670 W OAK ST
Second Line :
City : JENA
State : LA
Zip : 71342-4474
Country : US
Telephone Number : 318-992-1357
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2016
Last Update Date : 09/19/2016

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Directions to “ WHITNEY PRUDHOMME ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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