Provider Demographics
NPI:1699174565
Name:BANH, TIEN NIEM (PST018840 (PHARMD))
Entity type:Individual
Prefix:
First Name:TIEN
Middle Name:NIEM
Last Name:BANH
Suffix:
Gender:M
Credentials:PST018840 (PHARMD)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 ONTARIO AVE
Mailing Address - Street 2:PHARMACY DEPARMENT
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-2610
Mailing Address - Country:US
Mailing Address - Phone:985-732-7677
Mailing Address - Fax:985-732-7677
Practice Address - Street 1:401 ONTARIO AVE
Practice Address - Street 2:PHARMACY DEPARMENT
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-2610
Practice Address - Country:US
Practice Address - Phone:985-732-7677
Practice Address - Fax:985-732-7677
Is Sole Proprietor?:No
Enumeration Date:2014-08-17
Last Update Date:2014-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.018840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist