Organization
PHOENIX REXALL DRUGS, INC DBA PHOENIX HOME MEDICAL
Active
Other names
PHOENIX HOME MEDICAL
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CYNTHIA G WANN-JEANE CPT (OWNER)
(337) 238-5114
Entity
Organization
Contact information
Practice address
100 E FERTITTA BLVD, LEESVILLE, LA 71446-4737
(337) 238-5114
(337) 239-9200
Mailing address
PO BOX 172, LEESVILLE, LA 71496-0172
(337) 238-5114
(337) 239-9200
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
LA
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2365801
—
LA
01
—
C8065
BLUE CROSS FOR DME
LA
01
—
G7560
BLUE CROSS IV #
LA
Enumeration date
09/20/2006
Last updated
02/06/2015
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