Individual
TYLASHA GUSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4142 PONTCHARTRAIN DR, SLIDELL, LA 70458-5138
(985) 649-3490
Mailing address
4142 PONTCHARTRAIN DR, SLIDELL, LA 70458-5138
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PST.023599
LA
Other
Enumeration date
09/03/2020
Last updated
09/03/2020
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