Provider Demographics
NPI:1518337963
Name:BLANCHARD, BERT (RPH)
Entity Type:Individual
Prefix:MR
First Name:BERT
Middle Name:
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6431 HIGHWAY 44
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-8158
Mailing Address - Country:US
Mailing Address - Phone:225-257-1009
Mailing Address - Fax:225-257-1017
Practice Address - Street 1:6473 HIGHWAY 44 STE 101
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-8179
Practice Address - Country:US
Practice Address - Phone:225-257-1009
Practice Address - Fax:225-257-1017
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-28
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016926183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist