Provider Demographics
NPI:1194917328
Name:TIPPETT, WILLIAM (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:TIPPETT
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 RUIN CREEK RD
Mailing Address - Street 2:STE 102
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-5919
Mailing Address - Country:US
Mailing Address - Phone:252-492-4601
Mailing Address - Fax:252-433-4649
Practice Address - Street 1:511 RUIN CREEK RD
Practice Address - Street 2:STE 102
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-5919
Practice Address - Country:US
Practice Address - Phone:252-492-4601
Practice Address - Fax:252-433-4649
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-12
Last Update Date:2007-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9458183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist