MEDICARE: AUSTIN M PEAVY 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.023987	LA

General Provider Information

NPI Number	:	1891463592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTIN M PEAVY PHARMD

Provider Business Mailing Address
First Line	:	4116 JACKSON ST
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-2752
Country	:	US
Telephone Number	:	318-769-0148
Fax Number	:	844-601-3285

Provider Business Practice Location Address
First Line	:	4116 JACKSON ST
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-2752
Country	:	US
Telephone Number	:	318-769-0148
Fax Number	:	844-601-3285

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

Provider Enumeration Date	:	08/30/2021
Last Update Date	:	05/08/2026

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