Provider Demographics
NPI:1821447129
Name:PHILLIPS, WARREN (RPH)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:
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 1:1000 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-3455
Mailing Address - Country:US
Mailing Address - Phone:850-873-6888
Mailing Address - Fax:850-873-6163
Practice Address - Street 1:1352 W 15TH ST STE 8
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2000
Practice Address - Country:US
Practice Address - Phone:850-873-6888
Practice Address - Fax:850-873-6163
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS171341835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist