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General NPI Number Information
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NPI Number | 1801881446
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Entity Type | Individual
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Provider Name | CARA L PHILLIPS PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 530 NE GLEN OAK AVE
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City | PEORIA
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State | IL
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Zip | 61637-0001
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Country | US
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Telephone | 309-655-2285
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Fax |
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Provider Business Mailing Address
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Address Line | 10922 N NORTHTRAIL DR
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City | DUNLAP
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State | IL
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Zip | 61525-9287
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Country | US
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Telephone | 309-635-0737
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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 | 51289935
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License Number State | IL
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