Healthcare Provider Details

I. General information

NPI: 1942773213
Provider Name (Legal Business Name): TIOGA PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 10/27/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 SHREVEPORT HWY
PINEVILLE LA
71360
US

IV. Provider business mailing address

685 ROBERTSON RD
POLLOCK LA
71467-3809
US

V. Phone/Fax

Practice location:
  • Phone: 318-717-8555
  • Fax:
Mailing address:
  • Phone: 318-769-9751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEREMY POWELL
Title or Position: PHARMACIST
Credential: RPH
Phone: 318-769-9751