MEDICARE: DR. PHILLIP EARL FLANAGAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	051.293236	IL

General Provider Information

NPI Number	:	1265717870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP EARL FLANAGAN

Provider Business Mailing Address
First Line	:	17 JOHN ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10038-4010
Country	:	US
Telephone Number	:	212-619-7181
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 JOHN ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10038-4010
Country	:	US
Telephone Number	:	212-619-7181
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2011
Last Update Date	:	03/16/2012

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