Provider Demographics
NPI:1295126159
Name:BODIN, CHAD (RPH)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:BODIN
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 1:731 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHURCH POINT
Mailing Address - State:LA
Mailing Address - Zip Code:70525-4109
Mailing Address - Country:US
Mailing Address - Phone:337-684-1911
Mailing Address - Fax:337-684-1912
Practice Address - Street 1:731 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHURCH POINT
Practice Address - State:LA
Practice Address - Zip Code:70525-4109
Practice Address - Country:US
Practice Address - Phone:337-684-1911
Practice Address - Fax:337-684-1912
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA16380OtherLOUISIANA BOARD OF PHARMACY