Healthcare Provider Details

I. General information

NPI: 1619253010
Provider Name (Legal Business Name): CELINA T PHILIP RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2011
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 N. PONCE DELEON BLVD.
ST. AUGUSTINE FL
32084
US

IV. Provider business mailing address

2801 PONCE DELEON BLVD N
ST AUGUSTINE FL
32084-4457
US

V. Phone/Fax

Practice location:
  • Phone: 904-810-2200
  • Fax:
Mailing address:
  • Phone: 904-810-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS32194
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: