Provider Demographics
NPI:1184239501
Name:BILELLO, LINDSIE BROOKE
Entity type:Individual
Prefix:
First Name:LINDSIE
Middle Name:BROOKE
Last Name:BILELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 SAINT CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-3964
Mailing Address - Country:US
Mailing Address - Phone:985-868-4033
Mailing Address - Fax:
Practice Address - Street 1:1415 SAINT CHARLES ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-3964
Practice Address - Country:US
Practice Address - Phone:985-868-4033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.023592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist