Provider Demographics
NPI:1841774650
Name:PHILLIPS, JOAN M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:M
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-1550
Mailing Address - Country:US
Mailing Address - Phone:206-355-3259
Mailing Address - Fax:
Practice Address - Street 1:4611 ASSEMBLY DR STE H
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4841
Practice Address - Country:US
Practice Address - Phone:410-789-8454
Practice Address - Fax:410-789-8456
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20226183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty