Provider Demographics
NPI:1417639758
Name:HENRY-BOUDREAUX, KATRINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:HENRY-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 1:2015 W CACTUS RD APT 188
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-2786
Mailing Address - Country:US
Mailing Address - Phone:323-345-8101
Mailing Address - Fax:
Practice Address - Street 1:10641 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-7343
Practice Address - Country:US
Practice Address - Phone:623-583-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS026564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist