Provider Demographics
NPI:1033768585
Name:BOURGEOIS, ALEX (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:BOURGEOIS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3980 OLD STERLINGTON RD APT 1105
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2689
Mailing Address - Country:US
Mailing Address - Phone:504-421-7461
Mailing Address - Fax:
Practice Address - Street 1:2901 STERLINGTON RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2513
Practice Address - Country:US
Practice Address - Phone:318-323-0321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-07
Last Update Date:2019-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist