Provider Demographics
NPI:1578978664
Name:RICHERT, .TAMMY
Entity Type:Individual
Prefix:
First Name:.TAMMY
Middle Name:
Last Name:RICHERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 W FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518
Mailing Address - Country:US
Mailing Address - Phone:337-330-2549
Mailing Address - Fax:337-330-2223
Practice Address - Street 1:202 W FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518
Practice Address - Country:US
Practice Address - Phone:337-330-2549
Practice Address - Fax:337-330-2223
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADME.000546332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies