Provider Demographics
NPI:1699194738
Name:EADDY, PHILLIP (RPH)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:
Last Name:EADDY
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 1:3000 PROPRIETORS PL
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-8361
Mailing Address - Country:US
Mailing Address - Phone:843-884-2824
Mailing Address - Fax:843-884-2850
Practice Address - Street 1:3000 PROPRIETORS PL
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-8361
Practice Address - Country:US
Practice Address - Phone:843-884-2824
Practice Address - Fax:843-884-2850
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist