Healthcare Provider Details

I. General information

NPI: 1801430624
Provider Name (Legal Business Name): ROBERT JOSEPH ESPONGE III PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29148 S MONTPELIER RD
ALBANY LA
70711-4320
US

IV. Provider business mailing address

PO BOX 328
ALBANY LA
70711-0328
US

V. Phone/Fax

Practice location:
  • Phone: 337-339-2619
  • Fax:
Mailing address:
  • Phone: 337-339-2619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23252
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: