Provider Demographics
NPI:1164712097
Name:LEBLANC, DARREN ANTHONY
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:ANTHONY
Last Name:LEBLANC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 MANCUSO LN
Mailing Address - Street 2:APT. 112
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3594
Mailing Address - Country:US
Mailing Address - Phone:318-401-2623
Mailing Address - Fax:
Practice Address - Street 1:12308 PLANK RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70811-1037
Practice Address - Country:US
Practice Address - Phone:225-774-8563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.019227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist