Provider Demographics
NPI:1487946208
Name:DUBOIS, FREDERICK E (REGPH)
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:E
Last Name:DUBOIS
Suffix:
Gender:M
Credentials:REGPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-5612
Mailing Address - Country:US
Mailing Address - Phone:337-893-8790
Mailing Address - Fax:
Practice Address - Street 1:1150 W SAINT PETER ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3558
Practice Address - Country:US
Practice Address - Phone:337-367-9347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist