Provider Demographics
NPI:1073004040
Name:BODIN, AMIE S (PHARM D)
Entity Type:Individual
Prefix:MISS
First Name:AMIE
Middle Name:S
Last Name:BODIN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HUNDRED OAKS DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5482
Mailing Address - Country:US
Mailing Address - Phone:337-654-8835
Mailing Address - Fax:
Practice Address - Street 1:6770 JOHNSTON ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-6202
Practice Address - Country:US
Practice Address - Phone:337-706-7706
Practice Address - Fax:337-706-7729
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist