Provider Demographics
NPI:1033574637
Name:TLAIS, ALAA
Entity Type:Individual
Prefix:
First Name:ALAA
Middle Name:
Last Name:TLAIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3028 HUNTING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-4620
Mailing Address - Country:US
Mailing Address - Phone:270-320-1320
Mailing Address - Fax:
Practice Address - Street 1:3028 HUNTING CREEK DR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-4620
Practice Address - Country:US
Practice Address - Phone:270-320-1320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY018211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist