Provider Demographics
NPI:1134435068
Name:PHILLIPS, RICHARD A (PHARMACIST)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 HIDDEN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-3266
Mailing Address - Country:US
Mailing Address - Phone:864-325-9594
Mailing Address - Fax:
Practice Address - Street 1:230 HIDDEN HILLS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-3266
Practice Address - Country:US
Practice Address - Phone:864-325-9594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist