Provider Demographics
NPI:1881900421
Name:RAPHAEL, TONJA MELETTE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TONJA
Middle Name:MELETTE
Last Name:RAPHAEL
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 1:295 PONCHITOLAWA DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-6203
Mailing Address - Country:US
Mailing Address - Phone:504-319-0891
Mailing Address - Fax:985-898-2455
Practice Address - Street 1:295 PONCHITOLAWA DRIVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:504-319-0891
Practice Address - Fax:985-898-2455
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist