Provider Demographics
NPI:1922187327
Name:PHILLIPS, GUY M
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:M
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 HIGHWAY 82 E BLDG G
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:MS
Mailing Address - Zip Code:38751-2325
Mailing Address - Country:US
Mailing Address - Phone:662-887-4135
Mailing Address - Fax:662-887-9703
Practice Address - Street 1:903 HIGHWAY 82 E BLDG G
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:MS
Practice Address - Zip Code:38751-2325
Practice Address - Country:US
Practice Address - Phone:662-887-4135
Practice Address - Fax:662-887-9703
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST07986183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist