MEDICARE: AERYN MACKENSI PHILLIPS

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	183500000X	Pharmacist	RPH035955	GA

General Provider Information

NPI Number	:	1518820216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AERYN MACKENSI PHILLIPS

Provider Business Mailing Address
First Line	:	3686 FALLS TRL
Second Line	:
City	:	WINSTON
State	:	GA
Zip	:	30187-1593
Country	:	US
Telephone Number	:	404-242-1480
Fax Number	:

Provider Business Practice Location Address
First Line	:	2295 TOWNE LAKE PKWY
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-5520
Country	:	US
Telephone Number	:	770-517-2088
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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