Provider Demographics
NPI:1073745915
Name:TERRITO-TYNES, GENA M (PHARM D)
Entity Type:Individual
Prefix:
First Name:GENA
Middle Name:M
Last Name:TERRITO-TYNES
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2268 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5604
Mailing Address - Country:US
Mailing Address - Phone:504-914-7002
Mailing Address - Fax:
Practice Address - Street 1:4115 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-1533
Practice Address - Country:US
Practice Address - Phone:504-842-1900
Practice Address - Fax:504-842-1901
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist