Healthcare Provider Details

I. General information

NPI: 1992852636
Provider Name (Legal Business Name): TEWELDE'S LAFITTE DRUGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2695 JEAN LAFITTE BLVD
LAFITTE LA
70067
US

IV. Provider business mailing address

PO BOX 10
LAFITTE LA
70067-0010
US

V. Phone/Fax

Practice location:
  • Phone: 504-689-4122
  • Fax: 504-689-4125
Mailing address:
  • Phone: 504-689-4122
  • Fax: 504-689-4125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11262
License Number StateLA

VIII. Authorized Official

Name: DR. TADDESE TEWELDE
Title or Position: OWNER PHARMACIST
Credential: PHARMD
Phone: 504-689-4122