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General NPI Number Information
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NPI Number | 1417639758
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Entity Type | Individual
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Provider Name | KATRINA HENRY-BOUDREAUX PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/04/2023
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Last Update Date | 08/04/2023
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Provider Practice Location Address
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Address Line | 10641 W OLIVE AVE
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City | PEORIA
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State | AZ
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Zip | 85345-7343
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Country | US
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Telephone | 623-583-6688
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Fax |
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Provider Business Mailing Address
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Address Line | 2015 W CACTUS RD APT 188
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City | PHOENIX
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State | AZ
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Zip | 85029-2786
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Country | US
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Telephone | 323-345-8101
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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 | S026564
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License Number State | AZ
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