Healthcare Provider Details

I. General information

NPI: 1902245962
Provider Name (Legal Business Name): HEATHER PHILLEY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2013
Last Update Date: 06/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 DESIARD ST
MONROE LA
71203-4936
US

IV. Provider business mailing address

7920 DESIARD ST
MONROE LA
71203-4936
US

V. Phone/Fax

Practice location:
  • Phone: 318-343-1284
  • Fax: 318-345-5918
Mailing address:
  • Phone: 318-343-1284
  • Fax: 318-345-5918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16812
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: