Provider Demographics
NPI:1346708252
Name:CALLAIS, TIMOTHY JOHN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOHN
Last Name:CALLAIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:TIMOTHY
Other - Middle Name:JOHN
Other - Last Name:CALLAIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:TIM
Mailing Address - Street 1:108 E 83RD ST
Mailing Address - Street 2:
Mailing Address - City:CUT OFF
Mailing Address - State:LA
Mailing Address - Zip Code:70345-3820
Mailing Address - Country:US
Mailing Address - Phone:985-691-7770
Mailing Address - Fax:
Practice Address - Street 1:5831 W PARK AVE
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-1424
Practice Address - Country:US
Practice Address - Phone:985-868-9118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-10
Last Update Date:2019-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.016430183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist