Provider Demographics
NPI:1669072138
Name:ORRELL, PHILLIP (RPH)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:ORRELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3727 MEADOW SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-4662
Mailing Address - Country:US
Mailing Address - Phone:706-224-7299
Mailing Address - Fax:
Practice Address - Street 1:3130 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6977
Practice Address - Country:US
Practice Address - Phone:706-715-6236
Practice Address - Fax:706-715-6240
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017278183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist