MEDICARE: BORDELONS SUPER SAVE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	PHY.000087-IR	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912094194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BORDELONS SUPER SAVE INC

Provider Business Mailing Address
First Line	:	6920 PLANK RD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70811-6041
Country	:	US
Telephone Number	:	225-356-0654
Fax Number	:	225-357-7936

Provider Business Practice Location Address
First Line	:	6920 PLANK RD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70811-6041
Country	:	US
Telephone Number	:	225-356-0654
Fax Number	:	225-357-7936

Authorized Official
Title or Position	:	PHARMACIST
Name	:	JOHN DAVID MAY
Credential	:	PHARMD
Telephone Number	:	225-356-0654

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	02/22/2018

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