MEDICARE: DR. JUSTIN AUBREY PRESTRIDGE PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PST.018473	LA

General Provider Information

NPI Number	:	1255097234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN AUBREY PRESTRIDGE PHARMD

Provider Business Mailing Address
First Line	:	10661 ROCKY RD
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70706-1212
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1169 HIGHWAY 19
Second Line	:
City	:	SLAUGHTER
State	:	LA
Zip	:	70777-3404
Country	:	US
Telephone Number	:	225-286-7773
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2021
Last Update Date	:	11/13/2021

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