Provider Demographics
NPI:1881345361
Name:WRIGHT, PHILLIP GERARD
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:GERARD
Last Name:WRIGHT
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 1:931 W BEACH BLVD APT 1206
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542-6373
Mailing Address - Country:US
Mailing Address - Phone:402-613-9595
Mailing Address - Fax:
Practice Address - Street 1:2101 S 11TH ST
Practice Address - Street 2:
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410-3481
Practice Address - Country:US
Practice Address - Phone:402-874-9093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-16
Last Update Date:2022-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist