MEDICARE: RICHARD JOSEPH BORDELON R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	14169	LA

General Provider Information

NPI Number	:	1154697597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD JOSEPH BORDELON R.PH.

Provider Business Mailing Address
First Line	:	13707 COURSEY BLVD STE B
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70817-1306
Country	:	US
Telephone Number	:	225-636-5229
Fax Number	:	225-626-5239

Provider Business Practice Location Address
First Line	:	13707 COURSEY BLVD STE B
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70817-1306
Country	:	US
Telephone Number	:	225-636-5229
Fax Number	:	225-626-5239

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2012
Last Update Date	:	03/29/2012

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