Provider Demographics
NPI:1811657489
Name:PHIPPS, WILLIAM DAVID (RPH)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DAVID
Last Name:PHIPPS
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 1:2640 E SUNSHINE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2045
Mailing Address - Country:US
Mailing Address - Phone:417-885-1274
Mailing Address - Fax:
Practice Address - Street 1:2640 E SUNSHINE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2045
Practice Address - Country:US
Practice Address - Phone:417-885-1274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-23
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041757183500000X
OK11562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist