Provider Demographics
NPI:1225869217
Name:SAUCIER, ETHAN PAUL (PHARMD)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:PAUL
Last Name:SAUCIER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3141
Mailing Address - Country:US
Mailing Address - Phone:318-792-2215
Mailing Address - Fax:
Practice Address - Street 1:812 BELLEAU WOOD BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2584
Practice Address - Country:US
Practice Address - Phone:318-625-3769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.025442183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist