Provider Demographics
NPI:1134730690
Name:PHILLIPS, MIRANDA LEIGH I (PHARMD)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:LEIGH
Last Name:PHILLIPS
Suffix:I
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W WADE HAMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-1651
Mailing Address - Country:US
Mailing Address - Phone:864-968-1949
Mailing Address - Fax:864-968-2029
Practice Address - Street 1:101 W WADE HAMPTON BLVD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1651
Practice Address - Country:US
Practice Address - Phone:864-968-1949
Practice Address - Fax:864-968-2029
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist