Provider Demographics
NPI:1194095695
Name:STACIA, DUSTON K (PHARMD)
Entity type:Individual
Prefix:MR
First Name:DUSTON
Middle Name:K
Last Name:STACIA
Suffix:
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 1:9645 MEADOWDALE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70811-2135
Mailing Address - Country:US
Mailing Address - Phone:225-284-2825
Mailing Address - Fax:225-771-8197
Practice Address - Street 1:9645 MEADOWDALE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70811-2135
Practice Address - Country:US
Practice Address - Phone:225-284-2825
Practice Address - Fax:225-771-8197
Is Sole Proprietor?:No
Enumeration Date:2011-12-31
Last Update Date:2011-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18599183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist