Provider Demographics
NPI:1679627343
Name:BOSTICK, ELIZABETH HAYDEL
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:HAYDEL
Last Name:BOSTICK
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:MARY
Other - Last Name:HAYDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED PHARMACIS
Mailing Address - Street 1:11031 LAKE FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-2815
Mailing Address - Country:US
Mailing Address - Phone:504-251-1917
Mailing Address - Fax:504-896-2675
Practice Address - Street 1:210 STATE STREET
Practice Address - Street 2:REGION III PHARMACY
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118
Practice Address - Country:US
Practice Address - Phone:504-896-2671
Practice Address - Fax:504-896-2675
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA137021835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric