Provider Demographics
NPI:1013518646
Name:CARD, PHILIP ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:ANTHONY
Last Name:CARD
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 1:823 W STATE HIGHWAY 46 STE 1P1
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IN
Mailing Address - Zip Code:47460-6748
Mailing Address - Country:US
Mailing Address - Phone:812-829-2289
Mailing Address - Fax:812-829-6412
Practice Address - Street 1:823 W STATE HIGHWAY 46 STE 1P1
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IN
Practice Address - Zip Code:47460-6748
Practice Address - Country:US
Practice Address - Phone:812-829-2289
Practice Address - Fax:812-829-6412
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016247A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist