Active NPI
Mikey Philayvanh
- Pharmacist
- Youngsville, LA
National Provider Identifier
1245003995
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 025070
- Practice address
- 1500 Bonin Rd
Youngsville, LA 70592-5102 - Phone
- (337) 573-6177
- NPI assigned
- Nov 3, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 025070 | LA | Primary |
Addresses
Primary practice location
1500 Bonin Rd
Youngsville, LA 70592-5102
Mailing address
1368 Leed Champagne Rd
Saint Martinville, LA 70582-6627
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 025070 | LA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1698969600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698969600000",
"number": "1245003995",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1368 LEED CHAMPAGNE RD",
"city": "SAINT MARTINVILLE",
"state": "LA",
"postal_code": "705826627"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 BONIN RD",
"city": "YOUNGSVILLE",
"state": "LA",
"postal_code": "705925102",
"telephone_number": "337-573-6177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILAYVANH",
"first_name": "MIKEY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-11-03",
"last_updated": "2023-11-03",
"certification_date": "2023-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Pharmacist",
"state": "LA",
"license": "025070",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Youngsville, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.