Provider Demographics
NPI:1063701290
Name:SIPLE, MARK G (RPH)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:G
Last Name:SIPLE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ALLARA CT
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-2073
Mailing Address - Country:US
Mailing Address - Phone:302-838-0582
Mailing Address - Fax:
Practice Address - Street 1:1999 PULASKI HWY
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-1708
Practice Address - Country:US
Practice Address - Phone:302-832-9772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0002182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist