Provider Demographics
NPI:1841382645
Name:PHILLIPS, PAMELA D (RPH)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:D
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 WATER VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-3490
Mailing Address - Country:US
Mailing Address - Phone:724-779-4935
Mailing Address - Fax:
Practice Address - Street 1:1000 DUTCH RIDGE ROAD
Practice Address - Street 2:HERITAGE VALLEY HEALTH SYSTEM
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009
Practice Address - Country:US
Practice Address - Phone:724-773-2174
Practice Address - Fax:724-773-4679
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP033172L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0787-610001Medicaid
PA0787-610001Medicaid