Provider Demographics
NPI:1689378853
Name:PHILLIPS, CONNOR JAMESON (PHARMD)
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:JAMESON
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 W MACPHAIL RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-5263
Mailing Address - Country:US
Mailing Address - Phone:443-686-2030
Mailing Address - Fax:
Practice Address - Street 1:9106 PHILADELPHIA RD STE 100
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-4331
Practice Address - Country:US
Practice Address - Phone:410-687-8113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29033183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist