Provider Demographics
NPI:1568723047
Name:PHILLIPS, BRIAN B
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:B
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 1:4037 DURHAM CHAPEL HILL BLVD
Mailing Address - Street 2:T-1872
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2516
Mailing Address - Country:US
Mailing Address - Phone:919-765-0009
Mailing Address - Fax:919-213-4592
Practice Address - Street 1:4037 DURHAM CHAPEL HILL BLVD
Practice Address - Street 2:T-1872
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2516
Practice Address - Country:US
Practice Address - Phone:919-765-0009
Practice Address - Fax:919-213-4592
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist