MEDICARE: DALE PRESTENBACH 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	13126	LA

General Provider Information

NPI Number	:	1568474260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALE PRESTENBACH RPH

Provider Business Mailing Address
First Line	:	3300 HIGHWAY 308
Second Line	:
City	:	NAPOLEONVILLE
State	:	LA
Zip	:	70390-8904
Country	:	US
Telephone Number	:	985-414-0281
Fax Number	:

Provider Business Practice Location Address
First Line	:	5555 BURBANK DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70820-4014
Country	:	US
Telephone Number	:	985-414-0281
Fax Number	:

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	07/08/2007

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