Individual
KIBRY WAYNE BONVILLAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
600 ROUSSELL ST, HOUMA, LA 70360
(985) 381-4899
(985) 853-2091
Mailing address
600 ROUSSELL ST, HOUMA, LA 70360-4556
(985) 381-4899
(985) 853-2091
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
14316
LA
Other
Enumeration date
03/31/2011
Last updated
03/31/2011
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