Provider Demographics
NPI:1972924363
Name:BIOMEDICAL RESEARCH FOUNDATION OF NORTHWEST LOUISIANA
Entity type:Organization
Organization Name:BIOMEDICAL RESEARCH FOUNDATION OF NORTHWEST LOUISIANA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-675-4111
Mailing Address - Street 1:PO BOX 38050
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71133-8050
Mailing Address - Country:US
Mailing Address - Phone:318-675-4131
Mailing Address - Fax:318-675-4120
Practice Address - Street 1:1868 KINGS HWY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3659
Practice Address - Country:US
Practice Address - Phone:318-459-3719
Practice Address - Fax:318-459-3980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.005016-NU3336N0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336N0007XSuppliersPharmacyNuclear Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPHY.005016-NUOtherLOUISIANA BOARD OF PHARMACY PERMIT