Provider Demographics
NPI:1578643334
Name:TONORE, GERALD M (RPH)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:M
Last Name:TONORE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 JOHNSON STREET
Mailing Address - Street 2:
Mailing Address - City:TALLULAH
Mailing Address - State:LA
Mailing Address - Zip Code:71282-0000
Mailing Address - Country:US
Mailing Address - Phone:318-574-1655
Mailing Address - Fax:318-574-2175
Practice Address - Street 1:1009 JOHNSON STREET
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-0000
Practice Address - Country:US
Practice Address - Phone:318-574-1655
Practice Address - Fax:318-574-2175
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1130-IR183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1241342Medicaid
LA1241342Medicaid