Provider Demographics
NPI:1346522968
Name:TRIPEPI, MARK L (PHARMD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:TRIPEPI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8184 SPEACH DR
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9036
Mailing Address - Country:US
Mailing Address - Phone:315-638-9398
Mailing Address - Fax:
Practice Address - Street 1:8417 OSWEGO RD
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-8813
Practice Address - Country:US
Practice Address - Phone:315-622-0749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-10
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055903183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist