Healthcare Provider Details

I. General information

NPI: 1346852456
Provider Name (Legal Business Name): AMINAT TIJANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JEFFERSON HWY
JEFFERSON LA
70121-2429
US

IV. Provider business mailing address

1309 CARROLLTON AVE APT 336
METAIRIE LA
70005-1891
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-1179
  • Fax:
Mailing address:
  • Phone: 682-365-1540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.023536
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: