Provider Demographics
NPI:1003594003
Name:BIEBER, TINA MARIE (PD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:BIEBER
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 S UNION ST STE 2
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-5745
Mailing Address - Country:US
Mailing Address - Phone:337-948-7703
Mailing Address - Fax:337-205-6438
Practice Address - Street 1:1717 S UNION ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5745
Practice Address - Country:US
Practice Address - Phone:337-948-7703
Practice Address - Fax:337-205-6438
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist