Provider Demographics
NPI:1164861225
Name:REDDEN, SAMMY PAUL JR (PHARMD)
Entity Type:Individual
Prefix:
First Name:SAMMY
Middle Name:PAUL
Last Name:REDDEN
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 W ALABAMA AVE
Mailing Address - Street 2:
Mailing Address - City:MANY
Mailing Address - State:LA
Mailing Address - Zip Code:71449-3180
Mailing Address - Country:US
Mailing Address - Phone:337-513-5671
Mailing Address - Fax:
Practice Address - Street 1:407 BIENVILLE ST
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5702
Practice Address - Country:US
Practice Address - Phone:318-352-3141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA19803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19803OtherLOUISIANA BOARD OF PHARMACY