Provider Demographics
NPI:1154032126
Name:CHAMPAGNE, VALERIE G (PHARMD)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:G
Last Name:CHAMPAGNE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:SUE
Other - Last Name:GASPARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3009 BARES RD
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-2690
Mailing Address - Country:US
Mailing Address - Phone:337-258-5716
Mailing Address - Fax:
Practice Address - Street 1:3009 BROUSSARD ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-4140
Practice Address - Country:US
Practice Address - Phone:337-258-5716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist