Provider Demographics
NPI:1205025327
Name:PHILLIPS, AUSTIN TAYLOR (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:TAYLOR
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 E PINEHURST CT
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-9334
Mailing Address - Country:US
Mailing Address - Phone:336-816-1938
Mailing Address - Fax:
Practice Address - Street 1:2001 E PINEHURST CT
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9334
Practice Address - Country:US
Practice Address - Phone:336-816-1938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17751183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist