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General NPI Number Information
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NPI Number | 1508975236
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Entity Type | Individual
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Provider Name | BRADLEY JOSEPH DIGEROLAMO P.D., RPH
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Gender | Male
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 06/04/2021
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Provider Practice Location Address
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Address Line | 2064 WEST MAIN STREET
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City | LUTCHER
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State | LA
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Zip | 70071
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Country | US
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Telephone | 225-869-3535
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Fax | 225-869-8802
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Provider Business Mailing Address
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Address Line | 15726 HONEYWOOD AVE
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City | BATON ROUGE
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State | LA
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Zip | 70816-5515
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Country | US
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Telephone | 225-205-6832
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Fax | 225-869-8802
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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 | 14296
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 15940
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License Number State | LA
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