Individual
KYLE BOURGEOIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
932 CARROLLWOOD DR, LA PLACE, LA 70068-3304
(985) 652-1245
Mailing address
1686 CABANOSE ST, LUTCHER, LA 70071-5611
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PST.021708
LA
Other
Enumeration date
08/31/2016
Last updated
08/31/2016
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