Provider Demographics
NPI:1619035268
Name:BRUNET, SUSAN PICOU (PD)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:PICOU
Last Name:BRUNET
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7869 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4461
Mailing Address - Country:US
Mailing Address - Phone:985-873-8526
Mailing Address - Fax:
Practice Address - Street 1:7869 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4461
Practice Address - Country:US
Practice Address - Phone:985-873-8526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14667183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist