Healthcare Provider Details

I. General information

NPI: 1205672326
Provider Name (Legal Business Name): ALEX DAVID STANSBURY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 N 19TH ST
MONROE LA
71201-5734
US

IV. Provider business mailing address

1004 N 19TH ST
MONROE LA
71201-5734
US

V. Phone/Fax

Practice location:
  • Phone: 318-322-8326
  • Fax: 318-322-1084
Mailing address:
  • Phone: 318-322-8326
  • Fax: 318-322-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number024640
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: