Provider Demographics
NPI:1942073523
Name:PHILIPS, JACK II (PHARMD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:PHILIPS
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BRIDLE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4488
Mailing Address - Country:US
Mailing Address - Phone:732-575-2615
Mailing Address - Fax:
Practice Address - Street 1:104 HICKORY CORNER RD
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2460
Practice Address - Country:US
Practice Address - Phone:609-308-2887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04335900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist