Provider Demographics
NPI:1457724130
Name:DO, PHILLIP (PHARMD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:DO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 BEACHNUT AVE
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-6001
Mailing Address - Country:US
Mailing Address - Phone:805-404-8552
Mailing Address - Fax:
Practice Address - Street 1:22968 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-1634
Practice Address - Country:US
Practice Address - Phone:805-404-8552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist