Provider Demographics
NPI:1639767106
Name:PHILLIPS, GORDON ARTHUR (RPH)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:ARTHUR
Last Name:PHILLIPS
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 1:643 N RICHEY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-5039
Mailing Address - Country:US
Mailing Address - Phone:520-349-4901
Mailing Address - Fax:
Practice Address - Street 1:6900 E SUNRISE DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-0830
Practice Address - Country:US
Practice Address - Phone:520-299-3378
Practice Address - Fax:520-299-7289
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-09
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS008872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist