MEDICARE: ACADIANA PHARMACEUTICAL MEDICAL LLC

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	333600000X	Pharmacy	112604	AL
2	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0132833	OTHER		NCPDP

General Provider Information

NPI Number	:	1457348641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACADIANA PHARMACEUTICAL MEDICAL LLC

Provider Business Mailing Address
First Line	:	22203 A HWY 59
Second Line	:
City	:	ROBERTSDALE
State	:	AL
Zip	:	36567
Country	:	US
Telephone Number	:	251-945-1540
Fax Number	:	251-945-1542

Provider Business Practice Location Address
First Line	:	22203 A HWY 59
Second Line	:
City	:	ROBERTSDALE
State	:	AL
Zip	:	36567
Country	:	US
Telephone Number	:	251-945-1540
Fax Number	:	251-945-1542

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY LLC MEMBER
Name	:	ROBERT REYBURN ROBERTS III
Credential	:	RPH
Telephone Number	:	251-945-1540

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	09/11/2025

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Directions to “ACADIANA PHARMACEUTICAL MEDICAL LLC ” Practice Location

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