Provider Demographics
NPI:1063737427
Name:DAST, PHILIP RICHARD (RPH)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:RICHARD
Last Name:DAST
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8866 UNIONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SEBEWAING
Mailing Address - State:MI
Mailing Address - Zip Code:48759-9569
Mailing Address - Country:US
Mailing Address - Phone:989-883-3850
Mailing Address - Fax:989-883-9339
Practice Address - Street 1:8866 UNIONVILLE RD
Practice Address - Street 2:
Practice Address - City:SEBEWAING
Practice Address - State:MI
Practice Address - Zip Code:48759-9569
Practice Address - Country:US
Practice Address - Phone:989-883-3850
Practice Address - Fax:989-883-9339
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302021592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist