Healthcare Provider Details

I. General information

NPI: 1508975236
Provider Name (Legal Business Name): BRADLEY JOSEPH DIGEROLAMO P.D., RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2064 WEST MAIN STREET
LUTCHER LA
70071
US

IV. Provider business mailing address

15726 HONEYWOOD AVE
BATON ROUGE LA
70816-5515
US

V. Phone/Fax

Practice location:
  • Phone: 225-869-3535
  • Fax: 225-869-8802
Mailing address:
  • Phone: 225-205-6832
  • Fax: 225-869-8802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14296
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15940
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: