Provider Demographics
NPI:1932654688
Name:LEDOUX, BROOKE C (PHARMD)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:C
Last Name:LEDOUX
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 1:300 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHURCH POINT
Mailing Address - State:LA
Mailing Address - Zip Code:70525-3006
Mailing Address - Country:US
Mailing Address - Phone:337-684-5475
Mailing Address - Fax:337-684-5562
Practice Address - Street 1:300 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHURCH POINT
Practice Address - State:LA
Practice Address - Zip Code:70525-3006
Practice Address - Country:US
Practice Address - Phone:337-684-5475
Practice Address - Fax:337-684-5562
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist