Healthcare Provider Details

I. General information

NPI: 1063154979
Provider Name (Legal Business Name): BRETT BERTRAND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 N PARKERSON AVE
CROWLEY LA
70526-3613
US

IV. Provider business mailing address

105 ARAPAHOE DR
LAFAYETTE LA
70503-6238
US

V. Phone/Fax

Practice location:
  • Phone: 337-785-3102
  • Fax: 337-785-3109
Mailing address:
  • Phone: 337-580-1232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.016794
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: