Provider Demographics
NPI:1326583808
Name:ROUSSEL, GABRIELLE LARROQUE (PHARMD)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:LARROQUE
Last Name:ROUSSEL
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 1:1305 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JEANERETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70544-3640
Mailing Address - Country:US
Mailing Address - Phone:337-276-5001
Mailing Address - Fax:337-276-4202
Practice Address - Street 1:1305 MAIN ST
Practice Address - Street 2:
Practice Address - City:JEANERETTE
Practice Address - State:LA
Practice Address - Zip Code:70544-3640
Practice Address - Country:US
Practice Address - Phone:337-276-5001
Practice Address - Fax:337-276-4202
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA21850183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2434454Medicaid