Provider Demographics
NPI:1114253341
Name:PHILLIPS, JOHNNA ENLOE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHNNA
Middle Name:ENLOE
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 1:3529 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-3108
Mailing Address - Country:US
Mailing Address - Phone:336-540-0381
Mailing Address - Fax:336-540-0531
Practice Address - Street 1:3529 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3108
Practice Address - Country:US
Practice Address - Phone:336-540-0381
Practice Address - Fax:336-540-0531
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist