Provider Demographics
NPI:1962814897
Name:PHILLIPS, ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 RISTRA RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-8859
Mailing Address - Country:US
Mailing Address - Phone:575-317-0836
Mailing Address - Fax:
Practice Address - Street 1:900 W 2ND ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-3006
Practice Address - Country:US
Practice Address - Phone:575-622-1984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00005387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist