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Organization
PHOENIX REXALL DRUGS INC
Active
Organization
PHOENIX REXALL DRUGS INC
Active
Other names
PHOENIX PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA WANN CPT (MANAGER)
(337) 239-3421
Entity
Organization
Contact information
Practice address
101 N 3RD ST, LEESVILLE, LA 71446-4013
(337) 239-3421
(337) 392-6212
Mailing address
PO BOX 172, LEESVILLE, LA 71496-0172
(337) 239-3421
(337) 239-3422
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
891IR
LA
3336H0001X
Home Infusion Therapy Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1233854
—
LA
01
—
1907027
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/30/2006
Last updated
09/02/2011
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