Provider Demographics
NPI:1497060347
Name:NELSON, BAMBI AISHA (PHARMD)
Entity Type:Individual
Prefix:
First Name:BAMBI
Middle Name:AISHA
Last Name:NELSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5952 AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-3201
Mailing Address - Country:US
Mailing Address - Phone:225-355-6925
Mailing Address - Fax:225-356-0379
Practice Address - Street 1:5952 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-3201
Practice Address - Country:US
Practice Address - Phone:225-355-6925
Practice Address - Fax:225-356-0379
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist