Provider Demographics
NPI:1083974091
Name:MCLAUGHLIN, PHAEDRA (CPC, PAHM, CPHT)
Entity Type:Individual
Prefix:MS
First Name:PHAEDRA
Middle Name:
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:CPC, PAHM, CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 TIMMONS LN # 27093
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-5321
Mailing Address - Country:US
Mailing Address - Phone:346-855-8040
Mailing Address - Fax:
Practice Address - Street 1:2802 TIMMONS LN # 27093
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5321
Practice Address - Country:US
Practice Address - Phone:346-855-8040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230023306183700000X, 183700000X
NC37723183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician