Provider Demographics
NPI:1265831440
Name:TOUPS, GLENN MICHAEL
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:MICHAEL
Last Name:TOUPS
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 1:410 N CANAL BLVD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-2956
Mailing Address - Country:US
Mailing Address - Phone:985-446-3637
Mailing Address - Fax:985-446-9131
Practice Address - Street 1:410 N CANAL BLVD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-2956
Practice Address - Country:US
Practice Address - Phone:985-446-3637
Practice Address - Fax:985-446-9131
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist