Provider Demographics
NPI:1275836090
Name:FUSELIER, JUSTIN K (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:K
Last Name:FUSELIER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 FUSELIER RD
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-1528
Mailing Address - Country:US
Mailing Address - Phone:337-316-6537
Mailing Address - Fax:
Practice Address - Street 1:1013 E LANDRY ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-7388
Practice Address - Country:US
Practice Address - Phone:337-942-5738
Practice Address - Fax:373-481-0383
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
16719OtherLOUISIANA PHARMACIST