Provider Demographics
NPI:1063785822
Name:BORDELON, PAMELA NICOLE (RPH)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:NICOLE
Last Name:BORDELON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 MACARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3111
Mailing Address - Country:US
Mailing Address - Phone:318-442-5710
Mailing Address - Fax:318-442-4487
Practice Address - Street 1:604 MACARTHUR DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3111
Practice Address - Country:US
Practice Address - Phone:318-442-5710
Practice Address - Fax:318-442-4487
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12527183500000X
LA16068183500000X
FLPS30655183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist