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General NPI Number Information
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NPI Number | 1194124818
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Entity Type | Individual
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Provider Name | MS. STACIE BADEAUX
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Gender | Female
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Dates
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Enumeration Date | 08/19/2014
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Last Update Date | 08/19/2014
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Provider Practice Location Address
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Address Line | 1629 EAST CRESSWELL LANE
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City | OPELOUSAS
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State | LA
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Zip | 70570
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Country | US
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Telephone | 337-942-9720
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Fax | 337-948-3094
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Provider Business Mailing Address
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Address Line | 110 OSCAR RIVETTE RD
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City | ARNAUDVILLE
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State | LA
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Zip | 70512-5713
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Country | US
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Telephone | 337-298-4402
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Fax | 337-948-3094
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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 | 15777
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License Number State | LA
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