Provider Demographics
NPI:1457632283
Name:PHILLIPS, DEREK MICHAEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:MICHAEL
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3364 PRINCESS ANNE RD STE 501
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-2610
Mailing Address - Country:US
Mailing Address - Phone:757-468-5879
Mailing Address - Fax:757-368-4096
Practice Address - Street 1:3364 PRINCESS ANNE RD STE 501
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-2610
Practice Address - Country:US
Practice Address - Phone:757-468-5879
Practice Address - Fax:757-368-4096
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC19710183500000X
VA0202208438183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist