Provider Demographics
NPI:1689982902
Name:FREED, BRANDY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:
Last Name:FREED
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 N PARKERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-4355
Mailing Address - Country:US
Mailing Address - Phone:337-783-9084
Mailing Address - Fax:337-783-9085
Practice Address - Street 1:704 N PARKERSON AVE
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-4355
Practice Address - Country:US
Practice Address - Phone:337-783-9084
Practice Address - Fax:337-783-9085
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16773183500000X
ARPD10723183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA16773OtherLA BOARD OF PHARMACY
LA1895814Medicaid