Provider Demographics
NPI:1285918003
Name:ROUSSEL, BRANDY LYNN
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:LYNN
Last Name:ROUSSEL
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 1:300 MADEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DESTREHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70047-6127
Mailing Address - Country:US
Mailing Address - Phone:504-261-0260
Mailing Address - Fax:
Practice Address - Street 1:7015 PARK AVE
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-2850
Practice Address - Country:US
Practice Address - Phone:985-879-2407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist