| NPI | 1669948162 |
|---|---|
| Doing Business As | BROAD AVENUE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | PHAT QUACH Pharmacy Manager 504-309-4388 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2020-05-12 |