Provider Demographics
NPI:1912568718
Name:PITRE, BLAKE P
Entity Type:Individual
Prefix:MR
First Name:BLAKE
Middle Name:P
Last Name:PITRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 ROBERTA GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70363-5465
Mailing Address - Country:US
Mailing Address - Phone:985-876-0507
Mailing Address - Fax:985-798-7997
Practice Address - Street 1:13087 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:LAROSE
Practice Address - State:LA
Practice Address - Zip Code:70363
Practice Address - Country:US
Practice Address - Phone:985-693-7496
Practice Address - Fax:985-798-7997
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.008604-G183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist