=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225964661
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PHILLIP COLE PREJEAN PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2026
-----------------------------------------------------
Last Update Date | 06/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 518 PUJO ST
-----------------------------------------------------
City | LAKE CHARLES
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70601-4365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-761-5397
-----------------------------------------------------
Fax | 337-761-0831
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 518 PUJO ST
-----------------------------------------------------
City | LAKE CHARLES
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70601-4365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-761-5397
-----------------------------------------------------
Fax | 337-761-0831
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PST.023445
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------