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NPI Code Detail

MEDICARE: PATTI PHILLIPS RPH

MEDICARE: PATTI PHILLIPS RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist13534LA

General Provider Information

NPI Number : 1720365349
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATTI PHILLIPS RPH
Provider Business Mailing Address
First Line : 1720 W PRIEN LAKE RD
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70601-8361
Country : US
Telephone Number : 337-562-7802
Fax Number :
Provider Business Practice Location Address
First Line : 909 N YORKSHIRE CIR
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70605-6591
Country : US
Telephone Number : 337-540-2811
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2011
Last Update Date : 11/10/2011

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