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NPI Code Detail

MEDICARE: MR. ALFRED L BOURGEOIS RPH

MEDICARE:  MR. ALFRED L BOURGEOIS  RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist14902LA

General Provider Information

NPI Number : 1255613287
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ALFRED L BOURGEOIS RPH
Provider Business Mailing Address
First Line : 309 LEVERT DR
Second Line :
City : THIBODAUX
State : LA
Zip : 70301-3855
Country : US
Telephone Number : 985-449-1391
Fax Number :
Provider Business Practice Location Address
First Line : 21430 HIGHWAY 20
Second Line :
City : VACHERIE
State : LA
Zip : 70090-3614
Country : US
Telephone Number : 225-265-2191
Fax Number : 985-448-0917
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2011
Last Update Date : 02/26/2022

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Directions to “ MR. ALFRED L BOURGEOIS RPH” Practice Location

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