Healthcare Provider Details

I. General information

NPI: 1154487635
Provider Name (Legal Business Name): PHIL PARKHURST R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 BONITA ST
GRANTS NM
87020-2234
US

IV. Provider business mailing address

1208 BONITA ST
GRANTS NM
87020-2234
US

V. Phone/Fax

Practice location:
  • Phone: 505-287-4641
  • Fax: 505-287-7160
Mailing address:
  • Phone: 505-287-4641
  • Fax: 505-287-7160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3174
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: