Individual
LEROY J FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PD
Contact information
Practice address
1017 CECILIA BRIDGE HWY, BREAUX BRIDGE, LA 70517
(337) 667-6271
Mailing address
1789 GRAND ANSE HWY # B, BREAUX BRIDGE, LA 70517-7103
(337) 667-6977
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10017
LA
Other
Enumeration date
02/23/2007
Last updated
07/08/2007
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