Provider Demographics
NPI:1003198250
Name:NEVILLS, PHILLIP F (RPH)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:F
Last Name:NEVILLS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1799 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-2170
Mailing Address - Country:US
Mailing Address - Phone:630-896-6960
Mailing Address - Fax:630-896-3205
Practice Address - Street 1:1799 DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-2170
Practice Address - Country:US
Practice Address - Phone:630-896-6960
Practice Address - Fax:630-896-3205
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051034980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist