Provider Demographics
NPI:1013363944
Name:KOELZ, TAMMIE (RPH)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:
Last Name:KOELZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:TAMMIE
Other - Middle Name:FISHER
Other - Last Name:KOELZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:2701 JOHNSTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3263
Mailing Address - Country:US
Mailing Address - Phone:337-234-0197
Mailing Address - Fax:337-234-6939
Practice Address - Street 1:2701 JOHNSTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3263
Practice Address - Country:US
Practice Address - Phone:337-234-0197
Practice Address - Fax:337-234-6939
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.021504183500000X
AL15384183500000X
OH03317053183500000X
IL051.291424183500000X
MST-010616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist