Individual
DR. CHIANGCHANH PHOTHISANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
1080 EASTERN BLVD, MONTGOMERY, AL 36117-1919
(334) 277-5454
(334) 277-6252
Mailing address
93 MOUNTAIN TERRACE LN, WETUMPKA, AL 36093-3920
(334) 514-7808
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
14442
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14442
STATE LICENSE
AL
Enumeration date
11/16/2015
Last updated
11/16/2015
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