Provider Demographics
NPI:1104005636
Name:PHILLIPS, MELANIE ROBIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:ROBIN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-3636
Mailing Address - Country:US
Mailing Address - Phone:706-647-8267
Mailing Address - Fax:706-647-6526
Practice Address - Street 1:301 N CENTER ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3636
Practice Address - Country:US
Practice Address - Phone:706-647-8267
Practice Address - Fax:706-647-6526
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023893183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist