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General NPI Number Information
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NPI Number | 1326648338
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Entity Type | Individual
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Provider Name | RICARDO STEPHANN BOURGOIN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/28/2020
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 5448 WHITTLESEY BLVD
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City | COLUMBUS
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State | GA
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Zip | 31909-7295
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Country | US
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Telephone | 706-322-8950
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Fax |
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Provider Business Mailing Address
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Address Line | 3699 LEAR CT
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-7745
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Country | US
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Telephone | 678-510-9570
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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 | PS58805
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 067171-01
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH031163
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License Number State | GA
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