Provider Information for 1356199350
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PHENIX RX LLC
Other Names:Doing Business As:PARKWAY PHARMACYOrganization Subpart: NO
NPI: 1356199350
Last Updated: 2024-06-29
Certification Date: 2024-06-29
Certification Date: 2024-06-29
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1356199350 | ||||||||
| Enumeration Date | 2024-05-07 | ||||||||
| NPI Type | NPI-2 Organization | ||||||||
| Status | Active | ||||||||
| Authorized Official Information | Name: DESHARA PHENIX Title: Pharmacy owner Phone: 3183482053 | ||||||||
| Mailing Address | 107 BRIAR TRCE MONROE, LA 71203-6310 United States Phone: 318-348-2053 | Fax:318-665-0092 | ||||||||
| Primary Practice Address | 10374 HIGHWAY 165 N STE C STERLINGTON, LA 71280-3369 United States Phone: 318-812-2305 | Fax:318-665-0092 | ||||||||
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