Provider Demographics
NPI:1992932420
Name:PHILLIPS, LIBBY JANE (PHARMD)
Entity type:Individual
Prefix:MS
First Name:LIBBY
Middle Name:JANE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:LIBBY
Other - Middle Name:JANE
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 S. GREELEY HWY
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007
Mailing Address - Country:US
Mailing Address - Phone:307-635-4087
Mailing Address - Fax:307-637-3197
Practice Address - Street 1:700 S. GREELEY HWY
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007
Practice Address - Country:US
Practice Address - Phone:307-635-4087
Practice Address - Fax:307-637-3197
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00052183183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist