MEDICARE: MRS. RHONDA BOURGEOIS TOMB RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	13994	LA

General Provider Information

NPI Number	:	1417060161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RHONDA BOURGEOIS TOMB RPH

Provider Business Mailing Address
First Line	:	PO BOX 306
Second Line	:
City	:	JACKSON
State	:	LA
Zip	:	70748-0306
Country	:	US
Telephone Number	:	225-634-2470
Fax Number	:	225-634-7975

Provider Business Practice Location Address
First Line	:	1701 CHARTER ST
Second Line	:
City	:	JACKSON
State	:	LA
Zip	:	70748
Country	:	US
Telephone Number	:	225-634-2470
Fax Number	:	225-634-7975

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	07/08/2007

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