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General NPI Number Information
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NPI Number | 1730394875
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Entity Type | Individual
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Provider Name | DR. JACQUELYN MARIE LEBLANC
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Gender | Female
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4502 E 41ST ST SUITE 2H23
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City | TULSA
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State | OK
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Zip | 74135-2553
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Country | US
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Telephone | 918-660-3577
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Fax |
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Provider Business Mailing Address
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Address Line | 5396 E 81ST ST APT 634
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City | TULSA
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State | OK
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Zip | 74137-2261
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Country | US
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Telephone | 918-660-3577
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 13907
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License Number State | OK
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