Provider Demographics
NPI:1689046583
Name:LEBLANC, CRISTOPHER (PHARMD)
Entity type:Individual
Prefix:
First Name:CRISTOPHER
Middle Name:
Last Name:LEBLANC
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 BARKSDALE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-3902
Mailing Address - Country:US
Mailing Address - Phone:318-606-6305
Mailing Address - Fax:
Practice Address - Street 1:4000 BARKSDALE BOULEVARD
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-3902
Practice Address - Country:US
Practice Address - Phone:318-606-6305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019885183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist