Provider Demographics
NPI:1689878779
Name:ARCENEAUX, TIM ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:TIM
Middle Name:ANTHONY
Last Name:ARCENEAUX
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 1:606 LIBERTY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4622
Mailing Address - Country:US
Mailing Address - Phone:985-872-2552
Mailing Address - Fax:985-872-2532
Practice Address - Street 1:606 LIBERTY ST
Practice Address - Street 2:SUITE A
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4622
Practice Address - Country:US
Practice Address - Phone:985-872-2552
Practice Address - Fax:985-872-2532
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13409183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist