Provider Demographics
NPI:1912094194
Name:BORDELONS SUPER SAVE INC
Entity Type:Organization
Organization Name:BORDELONS SUPER SAVE INC
Other - Org Name:BORDELON'S SUPER SAVE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:225-356-0654
Mailing Address - Street 1:6920 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70811-6041
Mailing Address - Country:US
Mailing Address - Phone:225-356-0654
Mailing Address - Fax:225-357-7936
Practice Address - Street 1:6920 PLANK RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70811-6041
Practice Address - Country:US
Practice Address - Phone:225-356-0654
Practice Address - Fax:225-357-7936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.000087-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1240664Medicaid
LA1089410001Medicare NSC