Provider Demographics
NPI:1992010011
Name:CHARBONNET, STEVE DURAL
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:DURAL
Last Name:CHARBONNET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 GRAND CANYON DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-8633
Mailing Address - Country:US
Mailing Address - Phone:504-669-3870
Mailing Address - Fax:
Practice Address - Street 1:4400 S CLAIBORNE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-5106
Practice Address - Country:US
Practice Address - Phone:504-891-0975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist