Provider Demographics
NPI:1285727537
Name:TIPTON, SAM (RPH)
Entity type:Individual
Prefix:MR
First Name:SAM
Middle Name:
Last Name:TIPTON
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 1:909 PIONEER CIR W
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-6720
Mailing Address - Country:US
Mailing Address - Phone:940-464-0830
Mailing Address - Fax:940-464-7193
Practice Address - Street 1:117 PINER ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-9067
Practice Address - Country:US
Practice Address - Phone:940-382-5033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30903183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist