Provider Demographics
NPI:1245325810
Name:LEBLANC, MICHAEL FREDRICK (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:FREDRICK
Last Name:LEBLANC
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CALLEY COURT
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259
Mailing Address - Country:US
Mailing Address - Phone:904-287-8596
Mailing Address - Fax:
Practice Address - Street 1:5050 EDGEWOOD CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254
Practice Address - Country:US
Practice Address - Phone:904-783-5897
Practice Address - Fax:904-783-5089
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist