Provider Demographics
NPI:1902193543
Name:HOOPER, PHILLIP CHADWICK (RPH)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:CHADWICK
Last Name:HOOPER
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 1:2344 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5332
Mailing Address - Country:US
Mailing Address - Phone:336-227-9411
Mailing Address - Fax:336-228-1998
Practice Address - Street 1:2344 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5332
Practice Address - Country:US
Practice Address - Phone:336-227-9411
Practice Address - Fax:336-228-1998
Is Sole Proprietor?:No
Enumeration Date:2011-07-04
Last Update Date:2011-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist