Healthcare Provider Details

I. General information

NPI: 1629471651
Provider Name (Legal Business Name): PHYLIP R OHLER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2014
Last Update Date: 10/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 NATIONAL HWY
LAVALE MD
21502-7603
US

IV. Provider business mailing address

13811 PINTO RD SW
CUMBERLAND MD
21502-6231
US

V. Phone/Fax

Practice location:
  • Phone: 301-729-1004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22888
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0008267
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202211742
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: