Provider Demographics
NPI:1174838056
Name:THIBODAUX, SHWANDA CATRICE
Entity Type:Individual
Prefix:DR
First Name:SHWANDA
Middle Name:CATRICE
Last Name:THIBODAUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 BRASHEAR AVE
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1923
Mailing Address - Country:US
Mailing Address - Phone:985-380-3302
Mailing Address - Fax:
Practice Address - Street 1:815 BRASHEAR AVE
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1923
Practice Address - Country:US
Practice Address - Phone:985-380-3302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist