Provider Demographics
NPI:1093523722
Name:DAVIDSON, JUANITA JOY (PHARM D)
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:JOY
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 TIMBERLAWN DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4341
Mailing Address - Country:US
Mailing Address - Phone:337-358-0323
Mailing Address - Fax:
Practice Address - Street 1:1717 OAK PARK BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8977
Practice Address - Country:US
Practice Address - Phone:337-494-2990
Practice Address - Fax:337-494-2550
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist