Provider Demographics
NPI:1548571730
Name:PHILIPOSE, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:PHILIPOSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 WEST 253 RD STREET
Mailing Address - Street 2:HARBOR CITY
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-0799
Mailing Address - Country:US
Mailing Address - Phone:310-782-4116
Mailing Address - Fax:
Practice Address - Street 1:13141 HAWTHORNE BLVD
Practice Address - Street 2:132 ND STREET
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-4416
Practice Address - Country:US
Practice Address - Phone:310-675-9322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH56897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist