Provider Demographics
NPI:1922388636
Name:PHILIP, JEENU (RPH)
Entity Type:Individual
Prefix:
First Name:JEENU
Middle Name:
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 1:6800 SOUTHPOINT PKWY
Mailing Address - Street 2:SUITE 980
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6257
Mailing Address - Country:US
Mailing Address - Phone:904-296-9321
Mailing Address - Fax:904-296-9760
Practice Address - Street 1:6800 SOUTHPOINT PKWY
Practice Address - Street 2:SUITE 980
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6257
Practice Address - Country:US
Practice Address - Phone:904-296-9321
Practice Address - Fax:904-296-9760
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2016-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31021183500000X
NY043911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist