Healthcare Provider Details

I. General information

NPI: 1740838234
Provider Name (Legal Business Name): DEANNA M KIPLE R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 OLD FAIR GROUNDS WAY
KILMARNOCK VA
22482-3871
US

IV. Provider business mailing address

200 OLD FAIR GROUNDS WAY
KILMARNOCK VA
22482-3871
US

V. Phone/Fax

Practice location:
  • Phone: 804-435-6317
  • Fax:
Mailing address:
  • Phone: 804-435-6317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number02020011784
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number0202011784
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: