Provider Demographics
NPI:1053823831
Name:BRAUD, ROBIN (RPH)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:BRAUD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ASPHODEL AVE
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-7930
Mailing Address - Country:US
Mailing Address - Phone:985-688-3684
Mailing Address - Fax:
Practice Address - Street 1:1000 S ACADIA RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-5076
Practice Address - Country:US
Practice Address - Phone:985-449-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST013668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist