Provider Demographics
NPI:1164737565
Name:LEBLANC, JUSTIN M (PHARM D)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:M
Last Name:LEBLANC
Suffix:
Gender:M
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 1:1870 AIRLINE DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-2702
Mailing Address - Country:US
Mailing Address - Phone:318-746-8402
Mailing Address - Fax:
Practice Address - Street 1:1870 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-2702
Practice Address - Country:US
Practice Address - Phone:318-746-8402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18204183500000X
TX49282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist