Provider Demographics
NPI:1811097793
Name:SCHEXNAYDER, PHYLLIS ANGELA (PHARMACIST PD)
Entity type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:ANGELA
Last Name:SCHEXNAYDER
Suffix:
Gender:F
Credentials:PHARMACIST PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2624 VIDRINE RD
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586
Mailing Address - Country:US
Mailing Address - Phone:337-363-7533
Mailing Address - Fax:
Practice Address - Street 1:505 JACK MILLER RD
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586
Practice Address - Country:US
Practice Address - Phone:337-363-0941
Practice Address - Fax:337-363-0945
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1925304OtherNABP
LA1261637Medicaid
LA1925304OtherNABP