Provider Demographics
NPI:1235476813
Name:PHILLIPS, EMILY CLEVELAND
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:CLEVELAND
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SANDESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32550-7873
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:725 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SANDESTIN
Practice Address - State:FL
Practice Address - Zip Code:32550-7873
Practice Address - Country:US
Practice Address - Phone:850-622-3772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist