Healthcare Provider Details

I. General information

NPI: 1003198250
Provider Name (Legal Business Name): PHILLIP F NEVILLS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1799 DOUGLAS RD
MONTGOMERY IL
60538-2170
US

IV. Provider business mailing address

1799 DOUGLAS RD
MONTGOMERY IL
60538-2170
US

V. Phone/Fax

Practice location:
  • Phone: 630-896-6960
  • Fax: 630-896-3205
Mailing address:
  • Phone: 630-896-6960
  • Fax: 630-896-3205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051034980
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: