Andrea K Bourque, PHARMD
Individual provider Active NPI Pharmacist · Rayne, LA
NPI 1083496178 · NPPES record last updated Jul 8, 2024
Key facts
- NPI
- 1083496178
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PST.019587 (LA)
- Practice address
- 913 The Blvd
Rayne, LA 70578-6134 - Phone
- (337) 334-3399
- Fax
- (337) 334-3339
- NPI assigned
- Oct 16, 2023
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PST.019587 | LA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PST.019587 | LA | Yes |
Addresses
Primary practice location
913 The Blvd
Rayne, LA 70578-6134
Mailing address
414 Gordon Crocket Dr
Lafayette, LA 70508-5161
Phone (337) 230-2102
Other providers in Rayne, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.