Provider Demographics
NPI:1154917276
Name:CHRISTY, RIPPON
Entity type:Individual
Prefix:
First Name:RIPPON
Middle Name:
Last Name:CHRISTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 S SUTTON RD
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-2368
Mailing Address - Country:US
Mailing Address - Phone:630-497-2000
Mailing Address - Fax:
Practice Address - Street 1:680 S SUTTON RD
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-2368
Practice Address - Country:US
Practice Address - Phone:630-497-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-13
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051295759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist