=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295828408
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHIPPS ENTERPRISE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 09/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 185 SOUTH MAIN ST
-----------------------------------------------------
City | HILLSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-728-2731
-----------------------------------------------------
Fax | 276-728-3052
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1447
-----------------------------------------------------
City | HILLSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24343-7447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-728-2731
-----------------------------------------------------
Fax | 276-728-3502
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES
-----------------------------------------------------
Name | MATTIE PHIPPS
-----------------------------------------------------
Credential | BS PHARMACY
-----------------------------------------------------
Telephone | 276-728-2731
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 0201001611
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------