Provider Demographics
NPI:1609268564
Name:DESHOTELS, DAVID SR (PD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:DESHOTELS
Suffix:SR
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 DIJON DR STE C
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-7215
Mailing Address - Country:US
Mailing Address - Phone:225-330-6630
Mailing Address - Fax:225-308-2142
Practice Address - Street 1:5330 DIJON DR STE D
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-7214
Practice Address - Country:US
Practice Address - Phone:225-330-6630
Practice Address - Fax:225-308-2142
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014167183500000X, 1835P0018X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist