Provider Demographics
NPI:1760738751
Name:AUGUILLARD, TANECIA MARIE (PHARM,D)
Entity Type:Individual
Prefix:DR
First Name:TANECIA
Middle Name:MARIE
Last Name:AUGUILLARD
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 1:171 TURNBERRY DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-3629
Mailing Address - Country:US
Mailing Address - Phone:504-912-1148
Mailing Address - Fax:
Practice Address - Street 1:1238 SAINT CHARLES ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2745
Practice Address - Country:US
Practice Address - Phone:985-873-3613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist