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General NPI Number Information
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NPI Number | 1376141143
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Entity Type | Organization
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Legal Business Name | PHILLIPS PHARMACY, LLC
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Dates
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Enumeration Date | 10/14/2020
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Last Update Date | 01/26/2021
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Provider Practice Location Address
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Address Line | 7278 STATE HIGHWAY 14 E
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City | SPARTA
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State | MO
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Zip | 65753-9345
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Country | US
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Telephone | 417-973-9050
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 267
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City | SPARTA
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State | MO
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Zip | 65753-0267
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Country | US
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Telephone | 417-973-9050
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Fax | 417-278-3600
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Authorized Official
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Title or Position | OWNER
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Name | LIBBY PHILLIPS
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Credential | PHARM D
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Telephone | 417-973-9050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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