Provider Demographics
NPI:1154040335
Name:DUFRENE, DEREK DAIGLE (PHARMD)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:DAIGLE
Last Name:DUFRENE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 GABRIEL ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-3823
Mailing Address - Country:US
Mailing Address - Phone:985-860-4992
Mailing Address - Fax:
Practice Address - Street 1:4572 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-2772
Practice Address - Country:US
Practice Address - Phone:985-537-3296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.024403183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist