Organization
ALFONSO PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY ALFONSO PHARM D (OWNER)
(504) 905-5041
Entity
Organization
Contact information
Practice address
1203 ROBERT BLVD, SLIDELL, LA 70458-2015
(985) 445-1179
(985) 445-1279
Mailing address
1203 ROBERT BLVD, SLIDELL, LA 70458-2015
(504) 905-5041
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2205781
—
LA
Enumeration date
03/26/2018
Last updated
06/21/2022
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