Provider Demographics
NPI:1295047173
Name:POWELL, PHYLLIS W (RPH)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:W
Last Name:POWELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SUMMERHILL RD
Mailing Address - Street 2:
Mailing Address - City:SPOTSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08884-1251
Mailing Address - Country:US
Mailing Address - Phone:732-251-8202
Mailing Address - Fax:732-251-0618
Practice Address - Street 1:15 SUMMERHILL RD
Practice Address - Street 2:
Practice Address - City:SPOTSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08884-1251
Practice Address - Country:US
Practice Address - Phone:732-251-8202
Practice Address - Fax:732-251-0618
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01411300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist