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General NPI Number Information
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NPI Number | 1194449181
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Entity Type | Individual
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Provider Name | TAINASHIA PHILLIPS PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 869 HORIZON SOUTH PKWY
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City | GROVETOWN
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State | GA
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Zip | 30813-3025
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Country | US
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Telephone | 706-651-0306
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Fax |
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Provider Business Mailing Address
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Address Line | 4030 LAKEWOOD DR
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City | GROVETOWN
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State | GA
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Zip | 30813-1250
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Country | US
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Telephone | 520-226-7282
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 028797
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License Number State | GA
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