Healthcare Provider Details

I. General information

NPI: 1124412135
Provider Name (Legal Business Name): JUSTINE PHILLIPS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 N PEACE HAVEN RD
WINSTON SALEM NC
27106-4850
US

IV. Provider business mailing address

1955 N PEACE HAVEN RD
WINSTON SALEM NC
27106-4850
US

V. Phone/Fax

Practice location:
  • Phone: 336-765-6285
  • Fax: 336-768-3709
Mailing address:
  • Phone: 336-765-6285
  • Fax: 336-768-3709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number21511
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: