Provider Demographics
NPI:1720385875
Name:LADEAU, TOMMIE DAVIS (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:TOMMIE
Middle Name:DAVIS
Last Name:LADEAU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:DAVIS
Other - Middle Name:
Other - Last Name:LADEAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1911 HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3535
Mailing Address - Country:US
Mailing Address - Phone:800-939-2022
Mailing Address - Fax:555-230-9108
Practice Address - Street 1:1911 HAMPTON ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3535
Practice Address - Country:US
Practice Address - Phone:800-939-2022
Practice Address - Fax:855-523-0910
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12620183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist