Healthcare Provider Details

I. General information

NPI: 1306132550
Provider Name (Legal Business Name): ROBERT ANTHONY ZIPPRICH JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 W MORTON AVE
JACKSONVILLE IL
62650-2811
US

IV. Provider business mailing address

867 W CHAMBERS ST
JACKSONVILLE IL
62650-2369
US

V. Phone/Fax

Practice location:
  • Phone: 217-243-7818
  • Fax:
Mailing address:
  • Phone: 217-243-5250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.030630
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: