MEDICARE: MRS. BRANDY VIALLON

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	16612	LA

General Provider Information

NPI Number	:	1154791663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRANDY VIALLON

Provider Business Mailing Address
First Line	:	32555 BOWIE ST
Second Line	:
City	:	WHITE CASTLE
State	:	LA
Zip	:	70788-2503
Country	:	US
Telephone Number	:	225-545-2402
Fax Number	:

Provider Business Practice Location Address
First Line	:	32555 BOWIE ST
Second Line	:
City	:	WHITE CASTLE
State	:	LA
Zip	:	70788-2503
Country	:	US
Telephone Number	:	225-545-2402
Fax Number	:

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

Provider Enumeration Date	:	09/28/2015
Last Update Date	:	07/23/2020

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Directions to “ MRS. BRANDY VIALLON ” Practice Location

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