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NPI Code Detail

MEDICARE: DR. MELISSA BOUDREAU

MEDICARE: DR. MELISSA BOUDREAU
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
1183500000XPharmacist0013448CT

General Provider Information

NPI Number : 1407394950
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MELISSA BOUDREAU
Provider Business Mailing Address
First Line : 2117 BOSTON AVE
Second Line :
City : BRIDGEPORT
State : CT
Zip : 06610-3030
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2117 BOSTON AVE
Second Line :
City : BRIDGEPORT
State : CT
Zip : 06610-3030
Country : US
Telephone Number : 203-212-3800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2017
Last Update Date : 02/04/2017

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Directions to “ DR. MELISSA BOUDREAU ” Practice Location

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