Provider Demographics
NPI:1275887671
Name:CHELETTE, CANDACE THIBODEAUX (PHARMD)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:THIBODEAUX
Last Name:CHELETTE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 INDIAN MOUND BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2349
Mailing Address - Country:US
Mailing Address - Phone:337-302-2980
Mailing Address - Fax:318-342-5290
Practice Address - Street 1:2503 INDIAN MOUND BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-2349
Practice Address - Country:US
Practice Address - Phone:337-302-2980
Practice Address - Fax:318-342-5290
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist