Provider Demographics
NPI:1689923849
Name:PRIMEAUX, SHANE P (RPH)
Entity Type:Individual
Prefix:MR
First Name:SHANE
Middle Name:P
Last Name:PRIMEAUX
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 AMBASSADOR CAFFERY PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7266
Mailing Address - Country:US
Mailing Address - Phone:337-806-9000
Mailing Address - Fax:337-806-9074
Practice Address - Street 1:4811 AMBASSADOR CAFFERY PKWY STE 101
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7266
Practice Address - Country:US
Practice Address - Phone:337-806-9000
Practice Address - Fax:337-806-9074
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.015957183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist