Provider Demographics
NPI:1104134584
Name:EAST, VICTORIA J
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:J
Last Name:EAST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9650 AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-5505
Mailing Address - Country:US
Mailing Address - Phone:225-926-9604
Mailing Address - Fax:
Practice Address - Street 1:9650 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-5505
Practice Address - Country:US
Practice Address - Phone:225-926-9604
Practice Address - Fax:225-926-9691
Is Sole Proprietor?:No
Enumeration Date:2010-09-19
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17284183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist