Provider Demographics
NPI:1629314232
Name:BREAUX, AUDREY J (PHARMD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:J
Last Name:BREAUX
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9510 ELLERBE RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7406
Mailing Address - Country:US
Mailing Address - Phone:318-797-3272
Mailing Address - Fax:
Practice Address - Street 1:9510 ELLERBE RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7406
Practice Address - Country:US
Practice Address - Phone:318-797-3272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019971183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist