Provider Demographics
NPI:1760790091
Name:ANDREPONT, JAMES DIRK (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DIRK
Last Name:ANDREPONT
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 1:1717 S UNION ST STE 2
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-5745
Mailing Address - Country:US
Mailing Address - Phone:337-948-7703
Mailing Address - Fax:337-948-9975
Practice Address - Street 1:1717 S UNION ST STE 2
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5745
Practice Address - Country:US
Practice Address - Phone:337-948-7703
Practice Address - Fax:337-948-9975
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11388183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA08-09OtherMEDICATION ADMINISTRATION REGISTRY
LA1260916Medicaid
LA1260916Medicaid