Provider Demographics
NPI:1265717870
Name:FLANAGAN, PHILLIP EARL
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:EARL
Last Name:FLANAGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:PHILLIP
Other - Middle Name:EARL
Other - Last Name:FLANAGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:17 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4010
Mailing Address - Country:US
Mailing Address - Phone:212-619-7181
Mailing Address - Fax:
Practice Address - Street 1:17 JOHN ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4010
Practice Address - Country:US
Practice Address - Phone:212-619-7181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.2932361835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist