Provider Demographics
NPI:1205141223
Name:PEMBRICK, ALFRED (RPH)
Entity type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:
Last Name:PEMBRICK
Suffix:
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 1:5450 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-2733
Mailing Address - Country:US
Mailing Address - Phone:225-355-9782
Mailing Address - Fax:255-355-5332
Practice Address - Street 1:5450 PLANK RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-2733
Practice Address - Country:US
Practice Address - Phone:225-355-9782
Practice Address - Fax:255-355-5332
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11608183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist