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General NPI Number Information
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NPI Number | 1578661013
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Entity Type | Organization
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Legal Business Name | PHOENIX REXALL DRUGS, INC DBA PHOENIX HOME MEDICAL
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 02/06/2015
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Provider Practice Location Address
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Address Line | 100 E FERTITTA BLVD
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City | LEESVILLE
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State | LA
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Zip | 71446-4737
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Country | US
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Telephone | 337-238-5114
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Fax | 337-239-9200
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Provider Business Mailing Address
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Address Line | PO BOX 172
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City | LEESVILLE
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State | LA
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Zip | 71496-0172
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Country | US
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Telephone | 337-238-5114
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Fax | 337-239-9200
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CYNTHIA G WANN-JEANE
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Credential | CPT
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Telephone | 337-238-5114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | LA
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