Provider Demographics
NPI:1194449181
Name:PHILLIPS, TAINASHIA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TAINASHIA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-1250
Mailing Address - Country:US
Mailing Address - Phone:520-226-7282
Mailing Address - Fax:
Practice Address - Street 1:869 HORIZON SOUTH PKWY
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-3025
Practice Address - Country:US
Practice Address - Phone:706-651-0306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist