Provider Demographics
NPI:1518096551
Name:NEIMAN, PHILIP MARK (RPH)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:MARK
Last Name:NEIMAN
Suffix:
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 1:8745 SLATE RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-9648
Mailing Address - Country:US
Mailing Address - Phone:419-882-1502
Mailing Address - Fax:419-866-2164
Practice Address - Street 1:1510 S MCCORD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43560
Practice Address - Country:US
Practice Address - Phone:419-866-8943
Practice Address - Fax:419-866-2164
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-11107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist