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NPI Code Detail

MEDICARE: PHILLIP G WILLMORE RPH

MEDICARE: PHILLIP G WILLMORE RPH
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
1183500000XPharmacist041146MO

General Provider Information

NPI Number : 1326061805
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILLIP G WILLMORE RPH
Provider Business Mailing Address
First Line : 220 WOODVINE CT
Second Line :
City : FARMINGTON
State : MO
Zip : 63640-7686
Country : US
Telephone Number : 573-431-5702
Fax Number :
Provider Business Practice Location Address
First Line : 600 W KARSCH BLVD
Second Line :
City : FARMINGTON
State : MO
Zip : 63640-3342
Country : US
Telephone Number : 573-747-1591
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2006
Last Update Date : 04/16/2008

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Directions to “ PHILLIP G WILLMORE RPH” Practice Location

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