Healthcare Provider Details

I. General information

NPI: 1720411929
Provider Name (Legal Business Name): KEVIN PHILLIPS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2013
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 SOUTH HWY 64/264
MANTEO NC
27954-2027
US

IV. Provider business mailing address

PO BOX 2027
MANTEO NC
27954-2027
US

V. Phone/Fax

Practice location:
  • Phone: 252-473-5801
  • Fax: 252-473-2130
Mailing address:
  • Phone: 252-473-5801
  • Fax: 252-473-2130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13892
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: