Individual
MIKEY PHILAYVANH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 BONIN RD, YOUNGSVILLE, LA 70592-5102
(337) 573-6177
Mailing address
1368 LEED CHAMPAGNE RD, SAINT MARTINVILLE, LA 70582-6627
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
025070
LA
Other
Enumeration date
11/03/2023
Last updated
11/03/2023
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