Phillip Haan
Individual provider Active NPI Pharmacist · Eldridge, IA
NPI 1336764984 · NPPES record last updated Jun 9, 2020
Key facts
- NPI
- 1336764984
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 17504 (IA)
- Practice address
- 3208 S 25TH Ave
Eldridge, IA 52748-9306 - Phone
- (563) 370-2923
- NPI assigned
- Jun 9, 2020
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17504 | IA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 17504 | IA | Yes |
Addresses
Primary practice location
3208 S 25TH Ave
Eldridge, IA 52748-9306
Mailing address
3208 S 25TH Ave
Eldridge, IA 52748-9306
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | haanp@genesishealth.com |
Other providers in Eldridge, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 9, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.