Healthcare Provider Details

I. General information

NPI: 1104144245
Provider Name (Legal Business Name): BRAD JOSEPH FANGUY PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 ABIGAYLE ROW
SCOTT LA
70583-8909
US

IV. Provider business mailing address

106 ABIGAYLE ROW
SCOTT LA
70583-8909
US

V. Phone/Fax

Practice location:
  • Phone: 337-268-4023
  • Fax: 337-268-4043
Mailing address:
  • Phone: 337-268-4023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number45092
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: