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 ACTIVE LICENSE LIST

Name of Individual Submitting Request:
Company Affiliation or Licensee Name:
If Licensee, LA License Number:
Contact Phone Number:
Email to Receive File:
Date: 05/01/2024