Provider Demographics
NPI:1598838245
Name:SMITH, THERESE BOURGEOIS (RPH)
Entity Type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:BOURGEOIS
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:THERESE
Other - Middle Name:B
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:311 AUTUMN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-5363
Mailing Address - Country:US
Mailing Address - Phone:225-754-8660
Mailing Address - Fax:
Practice Address - Street 1:1039 E HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4757
Practice Address - Country:US
Practice Address - Phone:225-647-4182
Practice Address - Fax:225-644-0460
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14976183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist