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General NPI Number Information
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NPI Number | 1245325810
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Entity Type | Individual
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Provider Name | MICHAEL FREDRICK LEBLANC RPH
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5050 EDGEWOOD CT
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City | JACKSONVILLE
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State | FL
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Zip | 32254
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Country | US
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Telephone | 904-783-5897
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Fax | 904-783-5089
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Provider Business Mailing Address
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Address Line | 105 CALLEY COURT
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City | ST JOHNS
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State | FL
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Zip | 32259
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Country | US
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Telephone | 904-287-8596
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 14402
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License Number State | LA
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