Provider Demographics
NPI:1992879373
Name:THANNA GAIL C LELEUX
Entity type:Organization
Organization Name:THANNA GAIL C LELEUX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:LELEUX
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:337-229-4968
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LOREAUVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70552-0421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 N MAIN
Practice Address - Street 2:
Practice Address - City:LOREAUVILLE
Practice Address - State:LA
Practice Address - Zip Code:70552-0421
Practice Address - Country:US
Practice Address - Phone:337-229-4968
Practice Address - Fax:337-229-6010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LA1310IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1226114Medicaid
2030027OtherPK
LA1226114Medicaid