Provider Demographics
NPI:1649679796
Name:TASSIN, PAM (RPH)
Entity type:Individual
Prefix:MRS
First Name:PAM
Middle Name:
Last Name:TASSIN
Suffix:
Gender:F
Credentials:RPH
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:318-253-4075
Mailing Address - Fax:318-253-9148
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:318-253-4075
Practice Address - Fax:318-253-9148
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015963183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist