Provider Demographics
NPI:1174279475
Name:BOURGEOIS, MARLA KARR (RPH)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:KARR
Last Name:BOURGEOIS
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:PO BOX 1450
Mailing Address - Street 2:
Mailing Address - City:BUNA
Mailing Address - State:TX
Mailing Address - Zip Code:77612-1450
Mailing Address - Country:US
Mailing Address - Phone:409-289-1328
Mailing Address - Fax:
Practice Address - Street 1:1021 BEGLIS PKWY
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-5601
Practice Address - Country:US
Practice Address - Phone:337-527-6575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14271183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist