Provider Demographics
NPI:1902636962
Name:PHEN, ALEXANDRA (PHARMD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:PHEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 SE 13TH ST
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-9226
Mailing Address - Country:US
Mailing Address - Phone:954-806-0703
Mailing Address - Fax:
Practice Address - Street 1:600 US 31W BYP STE 12
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-4905
Practice Address - Country:US
Practice Address - Phone:270-782-0120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY024489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist