Provider Demographics
NPI:1154791663
Name:VIALLON, BRANDY
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:
Last Name:VIALLON
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 1:32555 BOWIE ST
Mailing Address - Street 2:
Mailing Address - City:WHITE CASTLE
Mailing Address - State:LA
Mailing Address - Zip Code:70788-2503
Mailing Address - Country:US
Mailing Address - Phone:225-545-2402
Mailing Address - Fax:
Practice Address - Street 1:32555 BOWIE ST
Practice Address - Street 2:
Practice Address - City:WHITE CASTLE
Practice Address - State:LA
Practice Address - Zip Code:70788-2503
Practice Address - Country:US
Practice Address - Phone:225-545-2402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-28
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist