Provider Demographics
NPI:1194325100
Name:LEBLANC, DAVID GLEN (RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:GLEN
Last Name:LEBLANC
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 FM 1960 RD E
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-2712
Mailing Address - Country:US
Mailing Address - Phone:281-852-4466
Mailing Address - Fax:281-852-0946
Practice Address - Street 1:6626 FM 1960 RD E
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-2712
Practice Address - Country:US
Practice Address - Phone:281-852-4466
Practice Address - Fax:281-852-0946
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist