Healthcare Provider Details

I. General information

NPI: 1902093552
Provider Name (Legal Business Name): PHILIP WILLIAM BANKS PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11167 TAMPA AVE
PORTER RANCH CA
91326-2254
US

IV. Provider business mailing address

11167 TAMPA AVE
PORTER RANCH CA
91326-2254
US

V. Phone/Fax

Practice location:
  • Phone: 818-360-1915
  • Fax: 818-368-4987
Mailing address:
  • Phone: 818-360-1915
  • Fax: 818-368-4987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number47038
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number47038
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number47038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: