Healthcare Provider Details

I. General information

NPI: 1598747206
Provider Name (Legal Business Name): KATHERINE BOUDREAUX PHARM. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATIE BOUDREAUX PHARMD

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S UNION BLVD
COLORADO SPRINGS CO
80910-3184
US

IV. Provider business mailing address

7955 TOMPKINS RD
FALCON CO
80831-6135
US

V. Phone/Fax

Practice location:
  • Phone: 719-344-6200
  • Fax: 719-344-7829
Mailing address:
  • Phone: 405-613-8715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number21619
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number21619
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: