Provider Demographics
NPI:1811210107
Name:LEMOINE, CHAD JOSEPH (PD)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:JOSEPH
Last Name:LEMOINE
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4070 RYAN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-2820
Mailing Address - Country:US
Mailing Address - Phone:337-478-5591
Mailing Address - Fax:337-477-2884
Practice Address - Street 1:4070 RYAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-2820
Practice Address - Country:US
Practice Address - Phone:337-478-5591
Practice Address - Fax:337-477-2884
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist