Provider Demographics
NPI:1235359514
Name:SOILEAU, CHRISTIE NICOLE (PD)
Entity Type:Individual
Prefix:MS
First Name:CHRISTIE
Middle Name:NICOLE
Last Name:SOILEAU
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4503 GREGORY ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-0592
Mailing Address - Country:US
Mailing Address - Phone:337-577-6349
Mailing Address - Fax:
Practice Address - Street 1:3231 CHITIMACHA TRAIL
Practice Address - Street 2:
Practice Address - City:CHARENTON
Practice Address - State:LA
Practice Address - Zip Code:70523
Practice Address - Country:US
Practice Address - Phone:337-923-9955
Practice Address - Fax:337-923-7791
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16226183500000X
TX37583183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA16226OtherPHARMACY STATE LICENSE
TX37583OtherPHARMACY STATE LICENSE