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General NPI Number Information
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NPI Number | 1255097234
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Entity Type | Individual
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Provider Name | JUSTIN AUBREY PRESTRIDGE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/13/2021
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Last Update Date | 11/13/2021
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Provider Practice Location Address
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Address Line | 1169 HIGHWAY 19
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City | SLAUGHTER
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State | LA
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Zip | 70777-3404
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Country | US
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Telephone | 225-286-7773
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Fax |
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Provider Business Mailing Address
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Address Line | 10661 ROCKY RD
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City | DENHAM SPRINGS
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State | LA
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Zip | 70706-1212
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PST.018473
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License Number State | LA
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