Provider Demographics
NPI:1194124818
Name:BADEAUX, STACIE
Entity type:Individual
Prefix:MS
First Name:STACIE
Middle Name:
Last Name:BADEAUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 OSCAR RIVETTE RD
Mailing Address - Street 2:
Mailing Address - City:ARNAUDVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70512-5713
Mailing Address - Country:US
Mailing Address - Phone:337-298-4402
Mailing Address - Fax:337-948-3094
Practice Address - Street 1:1629 EAST CRESSWELL LANE
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570
Practice Address - Country:US
Practice Address - Phone:337-942-9720
Practice Address - Fax:337-948-3094
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15777183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist