MEDICARE: DR. PHILIP WILLIAM BANKS PHARM.D.

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	47038	CA
2	1835G0303X	Geriatric Pharmacist	47038	CA
3	1835P1200X	Pharmacotherapy Pharmacist	47038	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RPH 47038	OTHER	CA	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1902093552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP WILLIAM BANKS PHARM.D.

Provider Business Mailing Address
First Line	:	11167 TAMPA AVE
Second Line	:
City	:	PORTER RANCH
State	:	CA
Zip	:	91326-2254
Country	:	US
Telephone Number	:	818-360-1915
Fax Number	:	818-368-4987

Provider Business Practice Location Address
First Line	:	11167 TAMPA AVE
Second Line	:
City	:	PORTER RANCH
State	:	CA
Zip	:	91326-2254
Country	:	US
Telephone Number	:	818-360-1915
Fax Number	:	818-368-4987

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

Provider Enumeration Date	:	09/27/2007
Last Update Date	:	09/27/2007

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