Individual
BRADLEY ALFONSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1260 FRONT ST, SLIDELL, LA 70458-2054
(985) 641-5557
Mailing address
1260 FRONT ST, SLIDELL, LA 70458-2054
(985) 641-5557
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
021186
LA
Other
Enumeration date
08/11/2015
Last updated
08/11/2015
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