Provider Demographics
NPI:1508975236
Name:DIGEROLAMO, BRADLEY JOSEPH (PD, RPH)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:JOSEPH
Last Name:DIGEROLAMO
Suffix:
Gender:M
Credentials:PD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15726 HONEYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-5515
Mailing Address - Country:US
Mailing Address - Phone:225-205-6832
Mailing Address - Fax:225-869-8802
Practice Address - Street 1:2064 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:LUTCHER
Practice Address - State:LA
Practice Address - Zip Code:70071
Practice Address - Country:US
Practice Address - Phone:225-869-3535
Practice Address - Fax:225-869-8802
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14296183500000X
LA15940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist