Provider Demographics
NPI:1639860703
Name:PHILLIPS, SUNNY LEIGH
Entity Type:Individual
Prefix:
First Name:SUNNY
Middle Name:LEIGH
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSCOMMON
Mailing Address - State:MI
Mailing Address - Zip Code:48653-9329
Mailing Address - Country:US
Mailing Address - Phone:989-275-5161
Mailing Address - Fax:989-275-1131
Practice Address - Street 1:425 N 5TH ST
Practice Address - Street 2:
Practice Address - City:ROSCOMMON
Practice Address - State:MI
Practice Address - Zip Code:48653-9329
Practice Address - Country:US
Practice Address - Phone:989-275-5161
Practice Address - Fax:989-275-1131
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303044769183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician