Provider Demographics
NPI:1326347899
Name:AUSTIN, ROYAL RICHARD (PD)
Entity Type:Individual
Prefix:
First Name:ROYAL
Middle Name:RICHARD
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 NORTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-2322
Mailing Address - Country:US
Mailing Address - Phone:504-259-6995
Mailing Address - Fax:
Practice Address - Street 1:2758 W 70TH ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71108-4502
Practice Address - Country:US
Practice Address - Phone:318-631-9891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10728183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist