Provider Demographics
NPI:1205058138
Name:PHILLIPS, VANESSA GABRIELLE (PHARMD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:GABRIELLE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:VELIKIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4301 BROADWAY, CPO 99
Mailing Address - Street 2:UNIVERSITY OF INCARNATE WORD-FEIK SCHOOL OF PHARMACY
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209
Mailing Address - Country:US
Mailing Address - Phone:210-883-1173
Mailing Address - Fax:210-822-1516
Practice Address - Street 1:4301 BROADWAY, CPO 99
Practice Address - Street 2:UNIVERSITY OF INCARNATE WORD-FEIK SCHOOL OF PHARMACY
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209
Practice Address - Country:US
Practice Address - Phone:210-883-1173
Practice Address - Fax:210-822-1516
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1835G0000X183500000X
PARP440176183500000X
TX48465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist