Provider Demographics
NPI:1558860742
Name:LEBEOUF, TRISTA (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRISTA
Middle Name:
Last Name:LEBEOUF
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 1:40494 FOX RUN DR
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-0712
Mailing Address - Country:US
Mailing Address - Phone:985-291-1003
Mailing Address - Fax:
Practice Address - Street 1:144 W 134TH PL
Practice Address - Street 2:
Practice Address - City:CUT OFF
Practice Address - State:LA
Practice Address - Zip Code:70345-4128
Practice Address - Country:US
Practice Address - Phone:985-325-9750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.022146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist