Healthcare Provider Details

I. General information

NPI: 1700068707
Provider Name (Legal Business Name): PHILLIP EDWARD ANDERSON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 MILLIKIN RD
COLUMBUS OH
43210-2200
US

IV. Provider business mailing address

1875 MILLIKIN RD
COLUMBUS OH
43210-2200
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-4020
  • Fax: 614-292-4790
Mailing address:
  • Phone: 614-292-4020
  • Fax: 614-292-4790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03-2-19402
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: