Provider Demographics
NPI:1912294778
Name:PHENIX, LAURIE B (RPH)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:B
Last Name:PHENIX
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:LAURIE
Other - Middle Name:B
Other - Last Name:REBELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:MAGELLAN RX MANAGEMENT
Mailing Address - Street 2:88 SILVA LANE, TECH 4, SUITE 110
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842
Mailing Address - Country:US
Mailing Address - Phone:401-334-1065
Mailing Address - Fax:401-619-5215
Practice Address - Street 1:88 SILVA LANE, TECH 4, SUITE 110
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842
Practice Address - Country:US
Practice Address - Phone:401-334-1065
Practice Address - Fax:401-619-5215
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH22873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist