Provider Demographics
NPI:1922398296
Name:BREAUX, TAMARA PRINCE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:PRINCE
Last Name:BREAUX
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 1:3895 HOBBINS RD
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70668-5407
Mailing Address - Country:US
Mailing Address - Phone:337-660-1542
Mailing Address - Fax:
Practice Address - Street 1:2825 RYAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7329
Practice Address - Country:US
Practice Address - Phone:337-434-1590
Practice Address - Fax:337-437-7639
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist