Provider Demographics
NPI:1386274405
Name:LIPE, JONATHAN PAUL
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:PAUL
Last Name:LIPE
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 1:6901 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-1186
Mailing Address - Country:US
Mailing Address - Phone:214-521-9991
Mailing Address - Fax:214-521-1946
Practice Address - Street 1:6901 PRESTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-1186
Practice Address - Country:US
Practice Address - Phone:214-521-9991
Practice Address - Fax:214-521-1946
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36801183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist