Provider Demographics
NPI:1720315013
Name:PHILLIPS, WILLIAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:PHILLIPS
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 1:8464 CHADBURN XING
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-7224
Mailing Address - Country:US
Mailing Address - Phone:334-354-7812
Mailing Address - Fax:
Practice Address - Street 1:6680 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-4240
Practice Address - Country:US
Practice Address - Phone:334-409-0611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-08
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48013183500000X
AL15862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist