Organization
PHARMACEUTICAL SPECIALTIES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL MARIST BOURG PHARM.D. (CO-OWNER)
(225) 767-1655
Entity
Organization
Contact information
Practice address
5211 ESSEN LN, SUITE 3, BATON ROUGE, LA 70809-3564
(225) 767-1655
(225) 767-1625
Mailing address
5211 ESSEN LN, SUITE 3, BATON ROUGE, LA 70809-3564
(225) 767-1655
(225) 767-1625
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
3625IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1264822
—
LA
Enumeration date
04/17/2007
Last updated
08/22/2020
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