Provider Demographics
NPI:1982262713
Name:VILCAN, BRADY J (PHARM D)
Entity Type:Individual
Prefix:
First Name:BRADY
Middle Name:J
Last Name:VILCAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 DAVID DR STE B
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1366
Mailing Address - Country:US
Mailing Address - Phone:985-384-7940
Mailing Address - Fax:
Practice Address - Street 1:1234 DAVID DR STE B
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1366
Practice Address - Country:US
Practice Address - Phone:985-384-7940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017183183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist