MEDICARE: MRS. CELINA T PHILIP RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS32194	FL

General Provider Information

NPI Number	:	1619253010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CELINA T PHILIP RPH

Provider Business Mailing Address
First Line	:	2801 PONCE DELEON BLVD N
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32084-4457
Country	:	US
Telephone Number	:	904-810-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 N. PONCE DELEON BLVD.
Second Line	:
City	:	ST. AUGUSTINE
State	:	FL
Zip	:	32084
Country	:	US
Telephone Number	:	904-810-2200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2011
Last Update Date	:	07/26/2012

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