Provider Demographics
NPI:1982077350
Name:PHILIPS, GAYLEEN
Entity type:Individual
Prefix:
First Name:GAYLEEN
Middle Name:
Last Name:PHILIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BANNING ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3486
Mailing Address - Country:US
Mailing Address - Phone:302-734-9903
Mailing Address - Fax:302-734-9308
Practice Address - Street 1:200 BANNING ST STE 100
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3486
Practice Address - Country:US
Practice Address - Phone:302-734-9903
Practice Address - Fax:302-734-9308
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-07
Last Update Date:2015-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0004786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist