Provider Demographics
NPI:1740502012
Name:REMBELSKI, PHILLIP JAMES (RPH)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:JAMES
Last Name:REMBELSKI
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 1:1334 HIGHLAND CV
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:MI
Mailing Address - Zip Code:48612-8568
Mailing Address - Country:US
Mailing Address - Phone:248-464-0683
Mailing Address - Fax:
Practice Address - Street 1:2110 S M 76
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-8737
Practice Address - Country:US
Practice Address - Phone:989-345-4884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist