Healthcare Provider Details

I. General information

NPI: 1063764272
Provider Name (Legal Business Name): TAMMY A ANTHON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4070 STERLINGTON RD
MONROE LA
71203-2536
US

IV. Provider business mailing address

4070 STERLINGTON RD
MONROE LA
71203-2536
US

V. Phone/Fax

Practice location:
  • Phone: 318-343-3390
  • Fax: 318-343-3504
Mailing address:
  • Phone: 318-343-3390
  • Fax: 318-343-3504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13291
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: