Healthcare Provider Details

I. General information

NPI: 1518861269
Provider Name (Legal Business Name): MEGAN ALYSSA BOUDOUIN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1492 AKRIDGE ST NW
ATLANTA GA
30314-2131
US

IV. Provider business mailing address

1492 AKRIDGE ST NW
ATLANTA GA
30314-2131
US

V. Phone/Fax

Practice location:
  • Phone: 504-214-9981
  • Fax:
Mailing address:
  • Phone: 504-214-9981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberRPH031707
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: