Provider Demographics
NPI:1417538422
Name:BULLARD DRUG AND WELLNESS
Entity Type:Organization
Organization Name:BULLARD DRUG AND WELLNESS
Other - Org Name:BULLARD DRUG AND WELLNESS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:ALANA SANDERS
Authorized Official - Last Name:BULLARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:318-495-1100
Mailing Address - Street 1:3515 MAIN ST. HWY 165
Mailing Address - Street 2:
Mailing Address - City:OLLA
Mailing Address - State:LA
Mailing Address - Zip Code:71465
Mailing Address - Country:US
Mailing Address - Phone:318-495-1100
Mailing Address - Fax:
Practice Address - Street 1:3515 MAIN ST. HWY 165
Practice Address - Street 2:
Practice Address - City:OLLA
Practice Address - State:LA
Practice Address - Zip Code:71465
Practice Address - Country:US
Practice Address - Phone:318-495-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy