Provider Demographics
NPI:1225112360
Name:PHIBBS, MARK DUDLEY (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DUDLEY
Last Name:PHIBBS
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 1:1124 PUESTA DEL SOL AVE
Mailing Address - Street 2:
Mailing Address - City:CAMANO ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98282-5502
Mailing Address - Country:US
Mailing Address - Phone:360-387-6072
Mailing Address - Fax:360-387-6072
Practice Address - Street 1:370 N. EAST CAMANO DR.
Practice Address - Street 2:
Practice Address - City:CAMANO ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98282
Practice Address - Country:US
Practice Address - Phone:360-387-5757
Practice Address - Fax:360-387-3901
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00011737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist