Healthcare Provider Details

I. General information

NPI: 1255168605
Provider Name (Legal Business Name): PIPPEN VALERY ZAGABE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2329 JAMES ST
SYRACUSE NY
13206-3070
US

IV. Provider business mailing address

2329 JAMES ST
SYRACUSE NY
13206-3070
US

V. Phone/Fax

Practice location:
  • Phone: 131-545-2608
  • Fax:
Mailing address:
  • Phone: 131-545-2608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number071953
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: