Provider Demographics
NPI:1922526482
Name:GASPARD, TIFFANY
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:GASPARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7162 HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:MANSURA
Mailing Address - State:LA
Mailing Address - Zip Code:71350-4351
Mailing Address - Country:US
Mailing Address - Phone:318-253-4073
Mailing Address - Fax:
Practice Address - Street 1:7162 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:MANSURA
Practice Address - State:LA
Practice Address - Zip Code:71350-4351
Practice Address - Country:US
Practice Address - Phone:318-253-4073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist