Request for DA/EA Documents

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

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):