Provider Demographics
NPI:1730164575
Name:BLONDEAU, GRETCHEN V (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:V
Last Name:BLONDEAU
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:A
Other - Last Name:VON HASSEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:1001 GAUSE BLVD
Mailing Address - Street 2:BOX 21 - PHARMACY
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2939
Mailing Address - Country:US
Mailing Address - Phone:985-280-8523
Mailing Address - Fax:
Practice Address - Street 1:1001 GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2939
Practice Address - Country:US
Practice Address - Phone:985-649-8523
Practice Address - Fax:985-649-8628
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13649183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No183500000XPharmacy Service ProvidersPharmacist