Provider Demographics
NPI:1598747206
Name:BOUDREAUX, KATHERINE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:BOUDREAUX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:7955 TOMPKINS RD
Mailing Address - Street 2:
Mailing Address - City:FALCON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-6135
Mailing Address - Country:US
Mailing Address - Phone:405-613-8715
Mailing Address - Fax:
Practice Address - Street 1:225 S UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3184
Practice Address - Country:US
Practice Address - Phone:719-344-6200
Practice Address - Fax:719-344-7829
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO216191835P1200X, 1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy