MEDICARE: JAEDA CROSBY RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PST.019514	LA

General Provider Information

NPI Number	:	1437438975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAEDA CROSBY RPH

Provider Business Mailing Address
First Line	:	3304 CYPRESS ST
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-7308
Country	:	US
Telephone Number	:	318-651-9171
Fax Number	:

Provider Business Practice Location Address
First Line	:	1025 GLENWOOD DR
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-5501
Country	:	US
Telephone Number	:	318-325-8346
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2011
Last Update Date	:	03/03/2026

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