Provider Demographics
NPI:1750681862
Name:BLACKMAN, TONYA THOMAS (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TONYA
Middle Name:THOMAS
Last Name:BLACKMAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 W ESPLANADE AVE
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2757
Mailing Address - Country:US
Mailing Address - Phone:504-467-8313
Mailing Address - Fax:
Practice Address - Street 1:820 W ESPLANADE AVE
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2757
Practice Address - Country:US
Practice Address - Phone:504-467-8313
Practice Address - Fax:504-467-9943
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1750681862Medicaid