Provider Demographics
NPI:1457882839
Name:PHILLIPS, RONDA JEAN (BS PHARMACY)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:JEAN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:MO
Mailing Address - Zip Code:65746-8679
Mailing Address - Country:US
Mailing Address - Phone:417-935-9003
Mailing Address - Fax:417-935-9013
Practice Address - Street 1:122 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:MO
Practice Address - Zip Code:65746-8679
Practice Address - Country:US
Practice Address - Phone:417-935-9003
Practice Address - Fax:417-935-9013
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist