Provider Demographics
NPI:1982071841
Name:BADWAN, TALA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TALA
Middle Name:
Last Name:BADWAN
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 1:1531 COUNTRY CLUB RD
Mailing Address - Street 2:APT 513
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5338
Mailing Address - Country:US
Mailing Address - Phone:770-241-1893
Mailing Address - Fax:
Practice Address - Street 1:1531 COUNTRY CLUB RD
Practice Address - Street 2:APT 513
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5338
Practice Address - Country:US
Practice Address - Phone:770-241-1893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist