Healthcare Provider Details

I. General information

NPI: 1447840426
Provider Name (Legal Business Name): SONYA PACE BUECHE PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 S RANGE AVE
DENHAM SPRINGS LA
70726-5566
US

IV. Provider business mailing address

2920 S RANGE AVE
DENHAM SPRINGS LA
70726-5566
US

V. Phone/Fax

Practice location:
  • Phone: 225-921-5021
  • Fax:
Mailing address:
  • Phone: 225-998-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0015899
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: