=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649690850
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DELBERT TIPPEY RPH, MSSM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2014
-----------------------------------------------------
Last Update Date | 04/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8739 INVERNESS PL
-----------------------------------------------------
City | TUSCALOOSA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35405-8958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-242-8448
-----------------------------------------------------
Fax | 205-758-4310
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8739 INVERNESS PL
-----------------------------------------------------
City | TUSCALOOSA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35405-8958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-242-8448
-----------------------------------------------------
Fax | 205-758-4310
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 12602
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 15569
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------