Provider Demographics
NPI:1801845342
Name:TIGER PHARMACY
Entity Type:Organization
Organization Name:TIGER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-704-0114
Mailing Address - Street 1:109A PARK WEST DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SCOTT
Mailing Address - State:LA
Mailing Address - Zip Code:70583-8902
Mailing Address - Country:US
Mailing Address - Phone:337-262-0189
Mailing Address - Fax:337-593-9751
Practice Address - Street 1:109A PARK WEST DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583-8902
Practice Address - Country:US
Practice Address - Phone:337-262-0189
Practice Address - Fax:337-593-9751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5552-IR3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1233871Medicaid