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General NPI Number Information
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NPI Number | 1497395305
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Entity Type | Individual
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Provider Name | DESHARA LATRICE PHENIX PHARMD
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Gender | Female
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Dates
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Enumeration Date | 01/08/2020
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 4070 STERLINGTON RD
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City | MONROE
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State | LA
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Zip | 71203-2536
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Country | US
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Telephone | 318-343-3390
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4611
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City | MONROE
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State | LA
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Zip | 71211-4611
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 65795
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PST.023302
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License Number State | LA
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