Healthcare Provider Details

I. General information

NPI: 1194810101
Provider Name (Legal Business Name): BARRERA BOUDREAUX & CASTELLON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9311 JEFFERSON HWY
RIVER RIDGE LA
70123
US

IV. Provider business mailing address

9311 JEFFERSON HWY
RIVER RIDGE LA
70123
US

V. Phone/Fax

Practice location:
  • Phone: 504-738-2277
  • Fax: 504-738-2281
Mailing address:
  • Phone: 504-738-2277
  • Fax: 504-738-2281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number3927IR
License Number StateLA

VIII. Authorized Official

Name: MR. RONALD JOSEPH LIOLINO
Title or Position: SECRETARY TREASURER
Credential:
Phone: 504-738-2277