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General NPI Number Information
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NPI Number | 1467099556
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Entity Type | Individual
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Provider Name | ADRIEL PETER JOSEPH
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Gender | Male
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Dates
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Enumeration Date | 12/08/2019
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Last Update Date | 12/08/2019
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Provider Practice Location Address
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Address Line | 205 E REYNOLDS DR
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City | RUSTON
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State | LA
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Zip | 71270-2852
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Country | US
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Telephone | 318-807-1190
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Fax | 318-807-2840
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Provider Business Mailing Address
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Address Line | 2312 OLIVER RD APT 219
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City | MONROE
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State | LA
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Zip | 71201-2967
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Country | US
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Telephone | 318-537-2683
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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 | 42893
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 020552
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PST.017298
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License Number State | LA
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