Provider Demographics
NPI:1184741555
Name:BOURGEOIS, RONALD JOSEPH (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:JOSEPH
Last Name:BOURGEOIS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 SOUTHDOWN WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-3992
Mailing Address - Country:US
Mailing Address - Phone:985-876-5697
Mailing Address - Fax:
Practice Address - Street 1:204 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538-3120
Practice Address - Country:US
Practice Address - Phone:337-828-0161
Practice Address - Fax:337-828-0920
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1264661Medicare ID - Type Unspecified