Provider Demographics
NPI:1215242532
Name:TYNDALL, HOWARD WRIGHT III (RPH)
Entity type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:WRIGHT
Last Name:TYNDALL
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:TREY
Other - Middle Name:
Other - Last Name:TYNDALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:650 SUMMERVILLE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-3864
Mailing Address - Country:US
Mailing Address - Phone:318-797-6618
Mailing Address - Fax:
Practice Address - Street 1:1500 LINE AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4639
Practice Address - Country:US
Practice Address - Phone:318-572-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist