Provider Demographics
NPI:1346557519
Name:TROTTER, TANYA (RPH)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:
Last Name:TROTTER
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 1:5828 LINE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-1532
Mailing Address - Country:US
Mailing Address - Phone:318-869-0669
Mailing Address - Fax:318-869-0671
Practice Address - Street 1:5828 LINE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-1532
Practice Address - Country:US
Practice Address - Phone:318-869-0669
Practice Address - Fax:318-869-0670
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist