=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942850136
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANETTE SIPPER PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2019
-----------------------------------------------------
Last Update Date | 09/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 E FRANKLIN ST
-----------------------------------------------------
City | HARTWELL
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30643-2204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-376-3212
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 DEER CREEK TRL
-----------------------------------------------------
City | HOSCHTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30548-2116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-477-2008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH028496
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------