MEDICARE: JOHN W 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	7375	NC

General Provider Information

NPI Number	:	1578148631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN W PHILLIPS

Provider Business Mailing Address
First Line	:	5008 HWY 70 WEST
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557
Country	:	US
Telephone Number	:	800-275-8777
Fax Number	:

Provider Business Practice Location Address
First Line	:	5008 HWY 70 WEST
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557
Country	:	US
Telephone Number	:	800-275-8777
Fax Number	:

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

Provider Enumeration Date	:	03/10/2021
Last Update Date	:	03/10/2021

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