Provider Demographics
NPI:1679187637
Name:DESPANIE, SHAYLA R
Entity Type:Individual
Prefix:
First Name:SHAYLA
Middle Name:R
Last Name:DESPANIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 EDISON ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-3338
Mailing Address - Country:US
Mailing Address - Phone:337-501-0280
Mailing Address - Fax:
Practice Address - Street 1:4313 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6703
Practice Address - Country:US
Practice Address - Phone:337-981-9673
Practice Address - Fax:337-347-5089
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-06
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.023553183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist