Organization
DUTCHTOWN PHARMACY L L C
Active
Other names
DUTCHTOWN PHARMACY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE TINNERELLO (MANAGER/OWNER)
(985) 320-5175
Entity
Organization
Contact information
Practice address
13011 HIGHWAY 73, GEISMAR, LA 70734-3021
(225) 677-5070
(225) 673-5060
Mailing address
1812 W THOMAS ST, HAMMOND, LA 70401-2945
(225) 677-5070
(225) 673-5060
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY-005662-IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2035369
PK
—
Enumeration date
06/20/2006
Last updated
03/11/2014
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