Provider Demographics
NPI:1992883276
Name:BABINEAUX, SHELBY ROCK (RPH)
Entity type:Individual
Prefix:MR
First Name:SHELBY
Middle Name:ROCK
Last Name:BABINEAUX
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 1:1620 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARTINVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70582-4310
Mailing Address - Country:US
Mailing Address - Phone:337-394-9772
Mailing Address - Fax:337-394-9773
Practice Address - Street 1:1620 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT MARTINVILLE
Practice Address - State:LA
Practice Address - Zip Code:70582-4310
Practice Address - Country:US
Practice Address - Phone:337-394-9772
Practice Address - Fax:337-394-9773
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA1362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1241075Medicaid
LA1241075Medicaid