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General NPI Number Information
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NPI Number | 1922398296
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Entity Type | Individual
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Provider Name | TAMARA PRINCE BREAUX PHARMD
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Gender | Female
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Dates
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Enumeration Date | 04/07/2011
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Last Update Date | 04/07/2011
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Provider Practice Location Address
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Address Line | 2825 RYAN ST
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City | LAKE CHARLES
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State | LA
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Zip | 70601-7329
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Country | US
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Telephone | 337-434-1590
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Fax | 337-437-7639
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Provider Business Mailing Address
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Address Line | 3895 HOBBINS RD
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City | VINTON
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State | LA
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Zip | 70668-5407
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Country | US
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Telephone | 337-660-1542
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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 | 018203
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License Number State | LA
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