Provider Demographics
NPI:1043595473
Name:ANDERSON, PHILIP DAVID II (RPH)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:DAVID
Last Name:ANDERSON
Suffix:II
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 1:600 WHITE CLAY CTR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-5455
Mailing Address - Country:US
Mailing Address - Phone:302-345-0335
Mailing Address - Fax:
Practice Address - Street 1:600 WHITE CLAY CTR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-5455
Practice Address - Country:US
Practice Address - Phone:302-366-0335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA10002329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist