Provider Demographics
NPI:1598831216
Name:HEATH, THOMAS PIPES (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:PIPES
Last Name:HEATH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:HEATH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:403 A SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269
Mailing Address - Country:US
Mailing Address - Phone:318-728-3353
Mailing Address - Fax:318-728-0703
Practice Address - Street 1:403 A SPENCER ST
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269
Practice Address - Country:US
Practice Address - Phone:318-728-3353
Practice Address - Fax:318-728-0703
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1259578Medicaid