Healthcare Provider Details

I. General information

NPI: 1104834738
Provider Name (Legal Business Name): RONALD J ROBICHAUX RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 CRESCENT AVE
LOCKPORT LA
70374-2735
US

IV. Provider business mailing address

616 CRESCENT AVE
LOCKPORT LA
70374-2735
US

V. Phone/Fax

Practice location:
  • Phone: 985-562-9140
  • Fax: 985-532-9205
Mailing address:
  • Phone: 985-562-9140
  • Fax: 985-532-9205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14293
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: