Healthcare Provider Details

I. General information

NPI: 1194917328
Provider Name (Legal Business Name): WILLIAM TIPPETT PHARM.D., R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2007
Last Update Date: 08/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 RUIN CREEK RD STE 102
HENDERSON NC
27536-5919
US

IV. Provider business mailing address

511 RUIN CREEK RD STE 102
HENDERSON NC
27536-5919
US

V. Phone/Fax

Practice location:
  • Phone: 252-492-4601
  • Fax: 252-433-4649
Mailing address:
  • Phone: 252-492-4601
  • Fax: 252-433-4649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9458
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: