Provider Demographics
NPI:1992852636
Name:TEWELDE'S LAFITTE DRUGS
Entity Type:Organization
Organization Name:TEWELDE'S LAFITTE DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TADDESE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEWELDE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:504-689-4122
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:LAFITTE
Mailing Address - State:LA
Mailing Address - Zip Code:70067-0010
Mailing Address - Country:US
Mailing Address - Phone:504-689-4122
Mailing Address - Fax:504-689-4125
Practice Address - Street 1:2695 JEAN LAFITTE BLVD
Practice Address - Street 2:
Practice Address - City:LAFITTE
Practice Address - State:LA
Practice Address - Zip Code:70067
Practice Address - Country:US
Practice Address - Phone:504-689-4122
Practice Address - Fax:504-689-4125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1913171OtherNABP
LA1252875Medicaid