Provider Demographics
NPI:1467997460
Name:BOURGEOIS, DAVID STEVEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:STEVEN
Last Name:BOURGEOIS
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 1:1595 OPOSSUMTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4313
Mailing Address - Country:US
Mailing Address - Phone:301-631-2013
Mailing Address - Fax:
Practice Address - Street 1:1595 OPOSSUMTOWN PIKE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4313
Practice Address - Country:US
Practice Address - Phone:301-631-2013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100002929183500000X
VA0202215428183500000X
TN40456183500000X
MD24609183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist