Provider Demographics
NPI:1649747478
Name:CAGE, EDCHARRA G (PST)
Entity Type:Individual
Prefix:
First Name:EDCHARRA
Middle Name:G
Last Name:CAGE
Suffix:
Gender:F
Credentials:PST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 CAMERON ISLES CT
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-5419
Mailing Address - Country:US
Mailing Address - Phone:225-955-8690
Mailing Address - Fax:
Practice Address - Street 1:195 N CANAL BLVD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-2995
Practice Address - Country:US
Practice Address - Phone:985-447-2456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022785183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist