Provider Demographics
NPI:1881932242
Name:PHILLIPS, DAVID MERRILL (RPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MERRILL
Last Name:PHILLIPS
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 1:3275 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-3004
Mailing Address - Country:US
Mailing Address - Phone:321-267-1233
Mailing Address - Fax:
Practice Address - Street 1:3275 GARDEN ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-3004
Practice Address - Country:US
Practice Address - Phone:321-267-1233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-19
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28698183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist