Healthcare Provider Details

I. General information

NPI: 1649971227
Provider Name (Legal Business Name): NICOLE ANN PHILLIPS PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8325 W INDIAN SCHOOL RD
PHOENIX AZ
85037-2125
US

IV. Provider business mailing address

2005 N 103RD AVE UNIT 12201
AVONDALE AZ
85392-4568
US

V. Phone/Fax

Practice location:
  • Phone: 623-245-7353
  • Fax: 623-245-7347
Mailing address:
  • Phone: 360-929-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberI026092
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: