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General NPI Number Information
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NPI Number | 1821425422
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Entity Type | Individual
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Provider Name | MARILYN SAMPOGNARO BERTRAND RPH
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Gender | Female
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Dates
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Enumeration Date | 09/27/2013
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Last Update Date | 09/27/2013
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Provider Practice Location Address
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Address Line | 4918 BARKSDALE BLVD
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City | BOSSIER CITY
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State | LA
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Zip | 71112-4555
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Country | US
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Telephone | 318-549-2107
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Fax | 318-549-2110
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Provider Business Mailing Address
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Address Line | 305 SUMMER LAKE DR
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City | BOSSIER CITY
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State | LA
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Zip | 71112-8785
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Country | US
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Telephone | 318-549-2107
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Fax | 318-549-2110
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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 | 14069
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License Number State | LA
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