Provider Demographics
NPI:1982860730
Name:GOUDREAU, DENIS B (RPH)
Entity Type:Individual
Prefix:MR
First Name:DENIS
Middle Name:B
Last Name:GOUDREAU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3840
Mailing Address - Country:US
Mailing Address - Phone:386-672-9013
Mailing Address - Fax:386-672-9013
Practice Address - Street 1:115 N SAINT ANDREWS DR
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-3840
Practice Address - Country:US
Practice Address - Phone:386-672-9013
Practice Address - Fax:386-672-9013
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0020183183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist