Provider Demographics
NPI:1437277324
Name:PREJEAN, GEORGIA TODD (RPH)
Entity type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:TODD
Last Name:PREJEAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 HERMAN DUPUIS RD
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-8530
Mailing Address - Country:US
Mailing Address - Phone:337-228-2504
Mailing Address - Fax:
Practice Address - Street 1:924 REES ST
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-4514
Practice Address - Country:US
Practice Address - Phone:337-332-6339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17326183500000X
GA016564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist