Healthcare Provider Details

I. General information

NPI: 1508080466
Provider Name (Legal Business Name): ROBERT GLENN AUCOIN PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 HENNESSY BLVD PHARMACY DEPARTMENT
BATON ROUGE LA
70808-4375
US

IV. Provider business mailing address

10240 HACKBERRY DR
BATON ROUGE LA
70809-2824
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-7652
  • Fax: 225-765-8410
Mailing address:
  • Phone: 225-293-3712
  • Fax: 225-765-8410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number11290
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: