Provider Demographics
NPI:1538420542
Name:BORROUSO, JULIE ANN DARDAR (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN DARDAR
Last Name:BORROUSO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 W THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-2942
Mailing Address - Country:US
Mailing Address - Phone:985-345-4901
Mailing Address - Fax:985-348-4908
Practice Address - Street 1:1711 W THOMAS ST
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-2942
Practice Address - Country:US
Practice Address - Phone:985-345-4901
Practice Address - Fax:985-348-4908
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist