Provider Demographics
NPI:1811205966
Name:LEBLANC, MARY SUSAN TIGRETT (RPH)
Entity Type:Individual
Prefix:
First Name:MARY SUSAN
Middle Name:TIGRETT
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 W HIGHWAY 14
Mailing Address - Street 2:
Mailing Address - City:DELCAMBRE
Mailing Address - State:LA
Mailing Address - Zip Code:70528-2308
Mailing Address - Country:US
Mailing Address - Phone:337-685-6851
Mailing Address - Fax:337-685-6853
Practice Address - Street 1:510 W HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:DELCAMBRE
Practice Address - State:LA
Practice Address - Zip Code:70528-2308
Practice Address - Country:US
Practice Address - Phone:337-685-6851
Practice Address - Fax:337-685-6853
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16049183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist