Provider Demographics
NPI:1346683133
Name:PHILLIPS, DEENA LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:DEENA
Middle Name:LYNN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8155 CYPRESS WAY
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-1699
Mailing Address - Country:US
Mailing Address - Phone:205-655-0402
Mailing Address - Fax:205-655-0402
Practice Address - Street 1:8155 CYPRESS WAY
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-1699
Practice Address - Country:US
Practice Address - Phone:205-655-0402
Practice Address - Fax:205-655-0402
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12320183500000X
MS09040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist