Provider Demographics
NPI:1568756849
Name:RODRIGUE, DEBORAH WAGUESPACK
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:WAGUESPACK
Last Name:RODRIGUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:T1450
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2409
Mailing Address - Country:US
Mailing Address - Phone:985-857-8620
Mailing Address - Fax:
Practice Address - Street 1:1727 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:T1450
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2409
Practice Address - Country:US
Practice Address - Phone:985-857-8620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14549183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist