Healthcare Provider Details

I. General information

NPI: 1598838245
Provider Name (Legal Business Name): THERESE BOURGEOIS SMITH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THERESE B SMITH RPH

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1039 E HIGHWAY 30
GONZALES LA
70737-4757
US

IV. Provider business mailing address

311 AUTUMN OAKS DR
BATON ROUGE LA
70810-5363
US

V. Phone/Fax

Practice location:
  • Phone: 225-647-4182
  • Fax: 225-644-0460
Mailing address:
  • Phone: 225-754-8660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14976
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: