Provider Demographics
NPI:1235221953
Name:PATER, SHARON KAY (RPH)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:KAY
Last Name:PATER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:KAY
Other - Last Name:GAUTREAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13133 S BRAXTON DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817
Mailing Address - Country:US
Mailing Address - Phone:225-756-8356
Mailing Address - Fax:225-756-7110
Practice Address - Street 1:13002 COURSEY BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816
Practice Address - Country:US
Practice Address - Phone:225-756-7110
Practice Address - Fax:225-756-7109
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1267783Medicaid
LA055605085Medicare ID - Type Unspecified