Provider Demographics
NPI:1174927966
Name:GAGE, PHIL (BS)
Entity type:Individual
Prefix:
First Name:PHIL
Middle Name:
Last Name:GAGE
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3842 W NEWBERRY RD STE 1G
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-4833
Mailing Address - Country:US
Mailing Address - Phone:352-373-3547
Mailing Address - Fax:352-373-1532
Practice Address - Street 1:3842 W NEWBERRY RD STE 1G
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-4833
Practice Address - Country:US
Practice Address - Phone:352-373-3547
Practice Address - Fax:352-373-1532
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS11104183500000X
3336L0003X
FLPH24053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacist
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy