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General NPI Number Information
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NPI Number | 1033768585
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Entity Type | Individual
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Provider Name | ALEX BOURGEOIS PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 09/07/2019
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Last Update Date | 09/07/2019
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Provider Practice Location Address
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Address Line | 2901 STERLINGTON RD
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City | MONROE
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State | LA
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Zip | 71203-2513
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Country | US
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Telephone | 318-323-0321
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Fax |
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Provider Business Mailing Address
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Address Line | 3980 OLD STERLINGTON RD APT 1105
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City | MONROE
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State | LA
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Zip | 71203-2689
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Country | US
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Telephone | 504-421-7461
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 023188
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License Number State | LA
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