Provider Demographics
NPI:1396776068
Name:PHILLERS
Entity type:Organization
Organization Name:PHILLERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GEBROE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:818-348-0860
Mailing Address - Street 1:20056 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2696
Mailing Address - Country:US
Mailing Address - Phone:818-348-0860
Mailing Address - Fax:818-884-3290
Practice Address - Street 1:20056 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2637
Practice Address - Country:US
Practice Address - Phone:818-348-0860
Practice Address - Fax:818-884-3290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY44960183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA449600Medicaid
CA4281500001Medicare ID - Type Unspecified