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Individual

DR. KENNETH GERARD BOUTTE JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PHARMD

Contact information

Practice address
416 MEMORIAL BLVD, PICAYUNE, MS 39466-5544
(601) 798-0330
Mailing address
11211 I 10 SERVICE RD, NEW ORLEANS, LA 70128-2248
(504) 458-9311

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
48331
TX
183500000X
Pharmacist
Primary
T-010671
MS

Other

Enumeration date
03/22/2011
Last updated
03/22/2011
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