Provider Demographics
NPI:1306544598
Name:DUPRE OF GONZALES LLC
Entity type:Organization
Organization Name:DUPRE OF GONZALES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:BERT
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:225-257-1009
Mailing Address - Street 1:6473 HIGHWAY 44 STE 101
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-8179
Mailing Address - Country:US
Mailing Address - Phone:252-571-0092
Mailing Address - Fax:
Practice Address - Street 1:6473 HIGHWAY 44 STE 101
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-8179
Practice Address - Country:US
Practice Address - Phone:225-257-1009
Practice Address - Fax:225-257-1017
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DUPRE OF GONZALES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-17
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy