Provider Demographics
NPI:1154926467
Name:PHILLIPS, JAMES MELVIN
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MELVIN
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 MAIN ST # 522
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3880
Mailing Address - Country:US
Mailing Address - Phone:781-665-7107
Mailing Address - Fax:781-662-9357
Practice Address - Street 1:516 MAIN ST # 522
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3880
Practice Address - Country:US
Practice Address - Phone:781-665-7107
Practice Address - Fax:781-662-9357
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH23018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty