Provider Demographics
NPI:1679726459
Name:TECHE ACTION BOARD INC
Entity Type:Organization
Organization Name:TECHE ACTION BOARD INC
Other - Org Name:TECHE ACTION CLINIC PHARMACY @ HOUMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIRBY
Authorized Official - Middle Name:
Authorized Official - Last Name:BONVILLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-355-2316
Mailing Address - Street 1:1014 W TUNNEL BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4050
Mailing Address - Country:US
Mailing Address - Phone:985-851-1717
Mailing Address - Fax:985-851-7247
Practice Address - Street 1:1014 W TUNNEL BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4050
Practice Address - Country:US
Practice Address - Phone:985-851-1717
Practice Address - Fax:985-851-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-24
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.006025-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1234982Medicaid
2117681OtherPK
LA1934137OtherNCPDP