Provider Demographics
NPI:1811441850
Name:ANCIAUX, PHILLIP MICHAEL (PHARMD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:MICHAEL
Last Name:ANCIAUX
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 1:3925 236TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-8455
Mailing Address - Country:US
Mailing Address - Phone:425-836-9173
Mailing Address - Fax:425-836-8728
Practice Address - Street 1:3925 236TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-8455
Practice Address - Country:US
Practice Address - Phone:425-836-9173
Practice Address - Fax:425-836-8728
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 60626956183500000X
IA22253183500000X
MN122151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist