Provider Demographics
NPI:1154593648
Name:MCCANN, DEBRA V (RPH, PD)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:V
Last Name:MCCANN
Suffix:
Gender:F
Credentials:RPH, PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 PRESCOTT RD
Mailing Address - Street 2:STE 110
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3900
Mailing Address - Country:US
Mailing Address - Phone:318-442-9846
Mailing Address - Fax:318-619-9515
Practice Address - Street 1:3311 PRESCOTT RD
Practice Address - Street 2:STE 110
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3900
Practice Address - Country:US
Practice Address - Phone:318-442-9846
Practice Address - Fax:318-619-9515
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11458183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA11458OtherLA BOARD OF PHARMACY