Provider Demographics
NPI:1598051799
Name:AGEE, PHILIP M (RPH)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:M
Last Name:AGEE
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 1:25 S GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-1228
Mailing Address - Country:US
Mailing Address - Phone:540-374-4821
Mailing Address - Fax:540-374-4831
Practice Address - Street 1:25 S GATEWAY DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-1228
Practice Address - Country:US
Practice Address - Phone:540-374-4821
Practice Address - Fax:540-374-4831
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-26
Last Update Date:2011-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist