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General NPI Number Information
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NPI Number | 1063154979
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Entity Type | Individual
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Provider Name | BRETT BERTRAND
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Gender | Male
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Dates
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Enumeration Date | 04/11/2022
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 1004 N PARKERSON AVE
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City | CROWLEY
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State | LA
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Zip | 70526-3613
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Country | US
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Telephone | 337-785-3102
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Fax | 337-785-3109
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Provider Business Mailing Address
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Address Line | 105 ARAPAHOE DR
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City | LAFAYETTE
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State | LA
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Zip | 70503-6238
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Country | US
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Telephone | 337-580-1232
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PST.016794
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License Number State | LA
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