Healthcare Provider Details

I. General information

NPI: 1255314019
Provider Name (Legal Business Name): PHILLIP ANTHONY DRUM PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 CONDOR CT
MARTINEZ CA
94553-5947
US

IV. Provider business mailing address

789 CONDOR DR
MARTINEZ CA
94553-5949
US

V. Phone/Fax

Practice location:
  • Phone: 925-335-0298
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number40493
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: