Healthcare Provider Details

I. General information

NPI: 1225964661
Provider Name (Legal Business Name): PHILLIP COLE PREJEAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 PUJO ST
LAKE CHARLES LA
70601-4365
US

IV. Provider business mailing address

518 PUJO ST
LAKE CHARLES LA
70601-4365
US

V. Phone/Fax

Practice location:
  • Phone: 337-761-5397
  • Fax: 337-761-0831
Mailing address:
  • Phone: 337-761-5397
  • Fax: 337-761-0831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.023445
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: