MEDICARE: VINCENT FREDERICK IPPOLITI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PCT.0014259	CT
2	183500000X	Pharmacist	RP00009614	NM

General Provider Information

NPI Number	:	1851804975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT FREDERICK IPPOLITI

Provider Business Mailing Address
First Line	:	2907 CERRILLOS RD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-2310
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2907 CERRILLOS RD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-2310
Country	:	US
Telephone Number	:	505-471-4660
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2017
Last Update Date	:	09/29/2022

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Directions to “ VINCENT FREDERICK IPPOLITI ” Practice Location

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