Healthcare Provider Details

I. General information

NPI: 1063803195
Provider Name (Legal Business Name): BRADLEY'S PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8115 E SAINT BERNARD HWY
SAINT BERNARD LA
70085-5424
US

IV. Provider business mailing address

8115 E SAINT BERNARD HWY
SAINT BERNARD LA
70085-5424
US

V. Phone/Fax

Practice location:
  • Phone: 504-682-5236
  • Fax: 504-682-6654
Mailing address:
  • Phone: 504-682-5236
  • Fax: 504-682-6654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number7026
License Number StateLA

VIII. Authorized Official

Name: SHARON ANN JEANFREAU
Title or Position: MANAGER
Credential: PHARMACY TECH
Phone: 504-682-5236