Healthcare Provider Details

I. General information

NPI: 1457348641
Provider Name (Legal Business Name): ACADIANA PHARMACEUTICAL MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22203 A HWY 59
ROBERTSDALE AL
36567
US

IV. Provider business mailing address

22203 A HWY 59
ROBERTSDALE AL
36567
US

V. Phone/Fax

Practice location:
  • Phone: 251-945-1540
  • Fax: 251-945-1542
Mailing address:
  • Phone: 251-945-1540
  • Fax: 251-945-1542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number112604
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

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