Provider Demographics
NPI:1881075026
Name:NEWHOPE, PHILLUP GRANT
Entity type:Individual
Prefix:
First Name:PHILLUP
Middle Name:GRANT
Last Name:NEWHOPE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-7803
Mailing Address - Country:US
Mailing Address - Phone:760-433-9634
Mailing Address - Fax:760-433-6067
Practice Address - Street 1:3925 MISSION AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-7803
Practice Address - Country:US
Practice Address - Phone:760-433-9634
Practice Address - Fax:760-433-6067
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist