Provider Demographics
NPI:1376141143
Name:PHILLIPS PHARMACY, LLC
Entity Type:Organization
Organization Name:PHILLIPS PHARMACY, LLC
Other - Org Name:PHILLIPS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:417-973-9050
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MO
Mailing Address - Zip Code:65753-0267
Mailing Address - Country:US
Mailing Address - Phone:417-973-9050
Mailing Address - Fax:417-278-3600
Practice Address - Street 1:7278 STATE HIGHWAY 14 E
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MO
Practice Address - Zip Code:65753-9345
Practice Address - Country:US
Practice Address - Phone:417-973-9050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy