Provider Demographics
NPI:1780272492
Name:JUNEAU, AUDRICK J JR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AUDRICK
Middle Name:J
Last Name:JUNEAU
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 GOOS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70611-6902
Mailing Address - Country:US
Mailing Address - Phone:337-794-5620
Mailing Address - Fax:
Practice Address - Street 1:3730 NELSON RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-2412
Practice Address - Country:US
Practice Address - Phone:337-656-7636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.013335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist