Provider Demographics
NPI:1225343254
Name:COMEAUX, GLENN PAUL
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:PAUL
Last Name:COMEAUX
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 1:1021 BEGLIS PKWY
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-5601
Mailing Address - Country:US
Mailing Address - Phone:337-527-6575
Mailing Address - Fax:
Practice Address - Street 1:1021 BEGLIS PKWY
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-5601
Practice Address - Country:US
Practice Address - Phone:337-527-6575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-14
Last Update Date:2010-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist