Provider Demographics
NPI:1316057235
Name:MONNERJAHN, BRAD W (PHARM D, RPH)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:W
Last Name:MONNERJAHN
Suffix:
Gender:M
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 ANGELA DR
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-3762
Mailing Address - Country:US
Mailing Address - Phone:504-231-3536
Mailing Address - Fax:
Practice Address - Street 1:804 W OAK ST
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-2700
Practice Address - Country:US
Practice Address - Phone:985-748-6847
Practice Address - Fax:985-748-6763
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist