Provider Demographics
NPI:1194324830
Name:TATMAN, SHANE A (RPH)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:A
Last Name:TATMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:SHANE
Other - Middle Name:ALBERT
Other - Last Name:TATMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:216 CHRISTIE LEA DR
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6804
Mailing Address - Country:US
Mailing Address - Phone:337-945-3771
Mailing Address - Fax:
Practice Address - Street 1:216 CHRISTIE LEA DR
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6804
Practice Address - Country:US
Practice Address - Phone:337-945-3771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist