Provider Demographics
NPI:1710323977
Name:PHILIP, PRASAD KUNNEL (RPH)
Entity Type:Individual
Prefix:
First Name:PRASAD
Middle Name:KUNNEL
Last Name:PHILIP
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 1:3502 W CAMELBACK RD
Mailing Address - Street 2:WALGREENS PHARMACY STORE # 5505
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85019
Mailing Address - Country:US
Mailing Address - Phone:602-976-5984
Mailing Address - Fax:
Practice Address - Street 1:3502 W CAMELBACK RD
Practice Address - Street 2:WALGREENS PHARMACY STORE # 5505
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85019
Practice Address - Country:US
Practice Address - Phone:602-976-5984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017760183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist