Provider Demographics
NPI:1235411133
Name:DEMEULENAERE, PHIL JOSEPH III (RPH)
Entity Type:Individual
Prefix:MR
First Name:PHIL
Middle Name:JOSEPH
Last Name:DEMEULENAERE
Suffix:III
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 1:3391 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:BRIDGMAN
Mailing Address - State:MI
Mailing Address - Zip Code:49106-9739
Mailing Address - Country:US
Mailing Address - Phone:269-465-9203
Mailing Address - Fax:
Practice Address - Street 1:1710 W JOHN BEERS RD
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-9409
Practice Address - Country:US
Practice Address - Phone:269-429-1153
Practice Address - Fax:269-429-1495
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019560A183500000X
MI5302030476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist