Provider Demographics
NPI:1770982738
Name:BORDELON, BRIDGET
Entity type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:
Last Name:BORDELON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:NEW ROADS
Mailing Address - State:LA
Mailing Address - Zip Code:70760-2623
Mailing Address - Country:US
Mailing Address - Phone:225-638-8616
Mailing Address - Fax:225-638-7862
Practice Address - Street 1:460 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:NEW ROADS
Practice Address - State:LA
Practice Address - Zip Code:70760-2623
Practice Address - Country:US
Practice Address - Phone:225-638-8616
Practice Address - Fax:225-638-7862
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist