Individual
TINA DETILLIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
108 ACADIA DR, RACELAND, LA 70394-0108
(985) 537-5255
Mailing address
5170 HIGHWAY 1, RACELAND, LA 70394-5170
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
14742
LA
Other
Enumeration date
03/01/2007
Last updated
07/08/2007
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