Provider Demographics
NPI:1750508586
Name:PEPERONE, ANTHONY J JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:J
Last Name:PEPERONE
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 PLACE ST. LAURENT
Mailing Address - Street 2:
Mailing Address - City:CONVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433
Mailing Address - Country:US
Mailing Address - Phone:504-319-1017
Mailing Address - Fax:
Practice Address - Street 1:517 PLACE ST. LAURENT
Practice Address - Street 2:
Practice Address - City:CONVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:504-319-1017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA9127OtherPHARMACY