Provider Demographics
NPI:1548582919
Name:PHILLIPS, CHRISTOPHER MATTHEW
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MATTHEW
Last Name:PHILLIPS
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 1:1 GRAND UNION PLZ
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-5123
Mailing Address - Country:US
Mailing Address - Phone:845-246-3441
Mailing Address - Fax:845-247-0419
Practice Address - Street 1:1 GRAND UNION PLZ
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-5123
Practice Address - Country:US
Practice Address - Phone:845-246-3441
Practice Address - Fax:845-247-0419
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053631183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist