ROLAND S WAGUESPACK MD NPI 1790906766

NPI Information

  • NPI: 1790906766
  • Provider Name: ROLAND S WAGUESPACK MD
  • Classification: Pharmacy - 333600000X
  • Entity Type: Organization
  • Doing Business As: ST PHILIP CLINIC
  • CLIA Number: 19D0457991
  • Address: 1108 ST JAMES STREET
    VACHERIE, LA
    ZIP 70090
  • Phone: (225) 265-4087

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NPI Details

ROLAND S WAGUESPACK MD is a pharmacy in Vacherie, LA. The provider is a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. ROLAND S WAGUESPACK MD NPI is 1790906766. The provider is registered as an organization entity type.
The provider Is Doing Business As St Philip Clinic.

The provider's business location address is:

1108 ST JAMES STREET
VACHERIE, LA
ZIP 70090
Phone: (225) 265-4087
Fax: (225) 265-4678

The provider's authorized official is Roland S Waguespack .
The authorized official title is Md and has the following contact phone number (225) 265-4087.

The CLIA number assigned to this NPI record is 19D0457991 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 5/1/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1333600000XPharmacy009974LOUISIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11442224MEDICAIDLOUISIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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