Provider Demographics
NPI:1417270810
Name:BOUDREAUX, ALVINA M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALVINA
Middle Name:M
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-2620
Mailing Address - Country:US
Mailing Address - Phone:504-274-5001
Mailing Address - Fax:
Practice Address - Street 1:4700 WICHERS DR STE 303
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3054
Practice Address - Country:US
Practice Address - Phone:504-309-9135
Practice Address - Fax:504-341-4140
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17390183500000X
LAPST.017390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist