Provider Demographics
NPI:1528812849
Name:PHILLIPSON, JOHN EDWARD JR (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EDWARD
Last Name:PHILLIPSON
Suffix:JR
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 1:3456 MEANDERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9616
Mailing Address - Country:US
Mailing Address - Phone:330-986-6040
Mailing Address - Fax:
Practice Address - Street 1:17674 MAHONING AVE
Practice Address - Street 2:
Practice Address - City:LAKE MILTON
Practice Address - State:OH
Practice Address - Zip Code:44429-9582
Practice Address - Country:US
Practice Address - Phone:330-654-3792
Practice Address - Fax:330-654-3301
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH033116071835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care