Individual
DWIGHT PAUL THIBODEAUX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
5551 CORPORATE BLVD, SUITE 102, BATON ROUGE, LA 70808-2567
(225) 924-1930
(225) 924-2620
Mailing address
36189 NORFOLK AVE, DENHAM SPRINGS, LA 70706-8587
(225) 924-1930
(225) 924-2620
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PST.016695
LA
Other
Enumeration date
10/10/2014
Last updated
10/10/2014
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