Provider Demographics
NPI:1508149659
Name:ST JUSTE, LOUIS DIKENS
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:DIKENS
Last Name:ST JUSTE
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 1:2500 OLD NORCROSS RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-2100
Mailing Address - Country:US
Mailing Address - Phone:678-710-5434
Mailing Address - Fax:
Practice Address - Street 1:1556 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-4601
Practice Address - Country:US
Practice Address - Phone:770-962-4946
Practice Address - Fax:770-962-0892
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019770183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist