Provider Demographics
NPI:1598440802
Name:STAMPS, BRANDON JAMES JR
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:JAMES
Last Name:STAMPS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4759 HICKERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-3425
Mailing Address - Country:US
Mailing Address - Phone:504-307-7321
Mailing Address - Fax:
Practice Address - Street 1:4142 PONTCHARTRAIN DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-5138
Practice Address - Country:US
Practice Address - Phone:985-649-3490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.024821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist