Individual
MARY ANN BLADES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
17544 TUNICA TRACE, LOUISIANA STATE PENITENTIARY, ANGOLA, LA 70712-1200
(225) 655-2313
Mailing address
17544 TUNICA TRCE, LOUISIANA STATE PENITENTIARY, ANGOLA, LA 70712-3029
(225) 655-2313
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
020006
LA
183500000X
Pharmacist
E-12675
MS
Other
Enumeration date
06/29/2013
Last updated
08/24/2015
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