Healthcare Provider Details

I. General information

NPI: 1982936886
Provider Name (Legal Business Name): BRAND DIRECT HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68397 TAMMANY TRACE DR
MANDEVILLE LA
70471-7776
US

IV. Provider business mailing address

68397 TAMMANY TRACE DR
MANDEVILLE LA
70471-7776
US

V. Phone/Fax

Practice location:
  • Phone: 985-809-8421
  • Fax: 866-227-5928
Mailing address:
  • Phone: 985-809-8421
  • Fax: 866-227-5928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY-006723-IR
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN CAMP
Title or Position: PRESIDENT
Credential:
Phone: 985-809-2181