Provider Demographics
NPI:1144729948
Name:PHILLIPS, BRIAN (PHARM D)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-1086
Mailing Address - Country:US
Mailing Address - Phone:614-205-2405
Mailing Address - Fax:
Practice Address - Street 1:825 MAIN ST
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-3733
Practice Address - Country:US
Practice Address - Phone:740-452-5485
Practice Address - Fax:740-452-6394
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03132331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist