Healthcare Provider Details

I. General information

NPI: 1154791663
Provider Name (Legal Business Name): MRS. BRANDY VIALLON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2015
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32555 BOWIE ST
WHITE CASTLE LA
70788-2503
US

IV. Provider business mailing address

32555 BOWIE ST
WHITE CASTLE LA
70788-2503
US

V. Phone/Fax

Practice location:
  • Phone: 225-545-2402
  • Fax:
Mailing address:
  • Phone: 225-545-2402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16612
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: