Provider Demographics
NPI:1770827875
Name:RUTLAND, POOJA TIFFANY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:POOJA
Middle Name:TIFFANY
Last Name:RUTLAND
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 N TRENTON ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-2325
Mailing Address - Country:US
Mailing Address - Phone:318-254-8713
Mailing Address - Fax:
Practice Address - Street 1:1401 N TRENTON ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2325
Practice Address - Country:US
Practice Address - Phone:318-254-8713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019738183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist