Provider Demographics
NPI:1053680439
Name:STOUTE, FRED D (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:D
Last Name:STOUTE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:412 OLIVE STREET
Mailing Address - City:ARNAUDVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70512-0299
Mailing Address - Country:US
Mailing Address - Phone:337-754-7481
Mailing Address - Fax:
Practice Address - Street 1:412 OLIVE ST
Practice Address - Street 2:
Practice Address - City:ARNAUDVILLE
Practice Address - State:LA
Practice Address - Zip Code:70512-6154
Practice Address - Country:US
Practice Address - Phone:337-754-7481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA8793OtherPHARMACIST LICENSE