Provider Demographics
NPI:1346595998
Name:BOUDREAU, RYAN JAMES (PHARMD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:JAMES
Last Name:BOUDREAU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:T-1449
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-5330
Mailing Address - Country:US
Mailing Address - Phone:504-888-7536
Mailing Address - Fax:
Practice Address - Street 1:4500 VETERANS MEMORIAL BLVD
Practice Address - Street 2:T-1449
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-5330
Practice Address - Country:US
Practice Address - Phone:504-888-7536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist