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General NPI Number Information
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NPI Number | 1083830517
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Entity Type | Organization
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Legal Business Name | PHARMACEUTICAL SPECIALTIES, LLC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5211 ESSEN LN SUITE 3
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City | BATON ROUGE
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State | LA
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Zip | 70809-3564
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Country | US
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Telephone | 225-767-1655
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Fax | 225-767-1625
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Provider Business Mailing Address
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Address Line | 5211 ESSEN LN SUITE 3
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City | BATON ROUGE
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State | LA
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Zip | 70809-3564
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Country | US
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Telephone | 225-767-1655
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Fax | 225-767-1625
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Authorized Official
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Title or Position | CO-OWNER
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Name | MICHAEL MARIST BOURG
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Credential | PHARM.D.
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Telephone | 225-767-1655
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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 | 3625IR
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License Number State | LA
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