Healthcare Provider Details

I. General information

NPI: 1194449181
Provider Name (Legal Business Name): TAINASHIA PHILLIPS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

869 HORIZON SOUTH PKWY
GROVETOWN GA
30813-3025
US

IV. Provider business mailing address

4030 LAKEWOOD DR
GROVETOWN GA
30813-1250
US

V. Phone/Fax

Practice location:
  • Phone: 706-651-0306
  • Fax:
Mailing address:
  • Phone: 520-226-7282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number028797
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: