Provider Demographics
NPI:1467099556
Name:JOSEPH, ADRIEL PETER
Entity Type:Individual
Prefix:
First Name:ADRIEL
Middle Name:PETER
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 OLIVER RD APT 219
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2967
Mailing Address - Country:US
Mailing Address - Phone:318-537-2683
Mailing Address - Fax:
Practice Address - Street 1:205 E REYNOLDS DR
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2852
Practice Address - Country:US
Practice Address - Phone:318-807-1190
Practice Address - Fax:318-807-2840
Is Sole Proprietor?:No
Enumeration Date:2019-12-08
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42893183500000X
KY020552183500000X
LAPST.017298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist