MEDICARE: MISS CARA L PHILLIPS PHARMD

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	51289935	IL

General Provider Information

NPI Number	:	1801881446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CARA L PHILLIPS PHARMD

Provider Business Mailing Address
First Line	:	10922 N NORTHTRAIL DR
Second Line	:
City	:	DUNLAP
State	:	IL
Zip	:	61525-9287
Country	:	US
Telephone Number	:	309-635-0737
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 NE GLEN OAK AVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61637-0001
Country	:	US
Telephone Number	:	309-655-2285
Fax Number	:

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	07/08/2007

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Directions to “ MISS CARA L PHILLIPS PHARMD” Practice Location

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