Individual
MR. SAM PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
321 JEFFERSON ST N, WADENA, MN 56482-1372
(218) 631-4050
(218) 631-2726
Mailing address
39364 MADSEN BEACH RD, BATTLE LAKE, MN 56515-9157
(218) 631-4050
(218) 631-2726
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
110695-8
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110695-8
STATE PHARMACIST LICENSE
MN
Enumeration date
12/01/2006
Last updated
07/08/2007
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