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General NPI Number Information
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NPI Number | 1003180365
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Entity Type | Individual
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Provider Name | TAMI LEIGH WILLINGHAM
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Gender | Female
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Dates
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Enumeration Date | 03/05/2012
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Last Update Date | 03/05/2012
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Provider Practice Location Address
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Address Line | 185 N LEWIS ST
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City | NEW IBERIA
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State | LA
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Zip | 70563-3925
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Country | US
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Telephone | 337-365-2323
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Fax |
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Provider Business Mailing Address
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Address Line | 103 CRANBERRY DR
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City | BROUSSARD
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State | LA
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Zip | 70518-9101
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 15302
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License Number State | LA
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