Healthcare Provider Details

I. General information

NPI: 1013708338
Provider Name (Legal Business Name): TIONA HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 07/13/2025
Certification Date: 07/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5349 CYPRESS ST
WEST MONROE LA
71291-7505
US

IV. Provider business mailing address

614 WARHAWK WAY
MONROE LA
71203-3159
US

V. Phone/Fax

Practice location:
  • Phone: 318-397-8152
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.025766
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: