Provider Demographics
NPI:1255613287
Name:BOURGEOIS, ALFRED L (RPH)
Entity type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:L
Last Name:BOURGEOIS
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 1:309 LEVERT DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-3855
Mailing Address - Country:US
Mailing Address - Phone:985-449-1391
Mailing Address - Fax:
Practice Address - Street 1:21430 HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:VACHERIE
Practice Address - State:LA
Practice Address - Zip Code:70090-3614
Practice Address - Country:US
Practice Address - Phone:225-265-2191
Practice Address - Fax:985-448-0917
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist