Individual
MR. KENNETH W BOUDREAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
3400 MILITARY HWY, PINEVILLE, LA 71360
(318) 640-8066
Mailing address
38 HAMMACK LN, BALL, LA 71405-3261
(318) 640-4448
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10753
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1896781
—
LA
Enumeration date
08/24/2010
Last updated
08/26/2010
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