Provider Demographics
NPI:1255910238
Name:PHILLIPS, SHANE M (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:M
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4875 HIGBEE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2566
Mailing Address - Country:US
Mailing Address - Phone:330-490-9034
Mailing Address - Fax:
Practice Address - Street 1:4875 HIGBEE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2566
Practice Address - Country:US
Practice Address - Phone:330-490-9034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy