Provider Demographics
NPI:1629775283
Name:HEBERT, ANNIE WATKINS
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:WATKINS
Last Name:HEBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:MARIE
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14175 BELLARD RD
Mailing Address - Street 2:
Mailing Address - City:WELSH
Mailing Address - State:LA
Mailing Address - Zip Code:70591-5924
Mailing Address - Country:US
Mailing Address - Phone:337-496-9832
Mailing Address - Fax:
Practice Address - Street 1:2500 N MARTIN LUTHER KING HWY
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-1307
Practice Address - Country:US
Practice Address - Phone:337-436-3909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist