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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
891IR
LA
3336H0001X
Home Infusion Therapy Pharmacy
—
—
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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