Provider Demographics
NPI:1356834030
Name:TASDA PROPERTIES, LLC
Entity Type:Organization
Organization Name:TASDA PROPERTIES, LLC
Other - Org Name:IDEAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:985-839-4668
Mailing Address - Street 1:PO BOX 771
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438-0771
Mailing Address - Country:US
Mailing Address - Phone:985-839-4668
Mailing Address - Fax:985-207-4670
Practice Address - Street 1:808 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-3634
Practice Address - Country:US
Practice Address - Phone:985-839-4668
Practice Address - Fax:985-207-4670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.007688-I3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy