Healthcare Provider Details

I. General information

NPI: 1285556498
Provider Name (Legal Business Name): GREGORY J TIPTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N 12TH ST
RICHMOND VA
23298-5009
US

IV. Provider business mailing address

2206 EDWARDS AVE
RICHMOND VA
23224-5237
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-3000
  • Fax:
Mailing address:
  • Phone: 919-344-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0203021585
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: