LOUISIANA BOARD OF DRUG AND DEVICE DISTRIBUTORS
12091 Bricksome Avenue, Suite B       Baton Rouge, LA 70816
(225) 295-8567       Fax: (225) 295-8568       admin@drugboard.la.gov       www.drugboard.la.gov
REQUEST FOR DA/EA DOCUMENTS

Requesting a copy of public record for disciplinary action taken by the LBDDD against the following Louisiana legend drug/device distributor license:
Louisiana License Number:
 
Request made by:
Name of Individual Submitting Request:
Company or LA Licensee Affiliation:
If Licensee, LA License Number:
Contact Phone Number:
Manner to receive document:
Email to address provided:
Mail to address provided:
Send to mailing address on record (Licensee only):