Provider Demographics
NPI:1053441246
Name:SHUTE'S PHARMACY LLC
Entity Type:Organization
Organization Name:SHUTE'S PHARMACY LLC
Other - Org Name:SHUTE'S PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WERGER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH/PIC
Authorized Official - Phone:337-942-2611
Mailing Address - Street 1:205 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6256
Mailing Address - Country:US
Mailing Address - Phone:337-942-2611
Mailing Address - Fax:337-942-8640
Practice Address - Street 1:205 N MAIN ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6256
Practice Address - Country:US
Practice Address - Phone:337-942-2611
Practice Address - Fax:337-942-8640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1013-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1238651Medicaid