Organization
PETES FAMILY PHARMACY LLC
Active
Other names
PETES PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL TINNERELLO RPH (OWNER)
(985) 320-5175
Entity
Organization
Contact information
Practice address
539 W RAILROAD AVE, INDEPENDENCE, LA 70443
(985) 878-6321
(985) 878-4613
Mailing address
1812 W THOMAS ST, HAMMOND, LA 70401-2945
(985) 878-6321
(985) 878-4613
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY.006092-IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1234958
—
LA
01
—
2028741
PK
—
Enumeration date
10/12/2006
Last updated
05/01/2017
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