Individual
PAGE BANKSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
19008 HIGHWAY 22, PONCHATOULA, LA 70454-6780
(985) 514-0242
Mailing address
49331 WHISKEY LN, TICKFAW, LA 70466-2605
(985) 514-0242
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
023932
LA
Other
Enumeration date
02/22/2024
Last updated
02/22/2024
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