Provider Demographics
NPI:1740689942
Name:BERTRAND, DONNY (RPH)
Entity type:Individual
Prefix:MR
First Name:DONNY
Middle Name:
Last Name:BERTRAND
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 CHARITY ST
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-4140
Mailing Address - Country:US
Mailing Address - Phone:337-893-4077
Mailing Address - Fax:337-893-4079
Practice Address - Street 1:3005 CHARITY ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-4140
Practice Address - Country:US
Practice Address - Phone:337-893-4077
Practice Address - Fax:337-893-4079
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist