Provider Demographics
NPI:1427533397
Name:MCEACHARN, WILFRED
Entity type:Individual
Prefix:
First Name:WILFRED
Middle Name:
Last Name:MCEACHARN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:LA
Mailing Address - Zip Code:71232-2819
Mailing Address - Country:US
Mailing Address - Phone:318-878-2261
Mailing Address - Fax:318-878-9870
Practice Address - Street 1:213 DEPOT ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:LA
Practice Address - Zip Code:71232-2819
Practice Address - Country:US
Practice Address - Phone:318-878-2261
Practice Address - Fax:318-878-9870
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11922183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1114944022Medicaid