Provider Demographics
NPI:1063768620
Name:DIPPOLD, DANIEL J (RPH)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:DIPPOLD
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 1:2901 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-5216
Mailing Address - Country:US
Mailing Address - Phone:814-723-8250
Mailing Address - Fax:814-723-8269
Practice Address - Street 1:2901 MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-5216
Practice Address - Country:US
Practice Address - Phone:814-723-8250
Practice Address - Fax:814-723-8269
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044317T183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist