Provider Demographics
NPI:1073680229
Name:SCHIPPER, JOELLYN M (CPHT)
Entity Type:Individual
Prefix:
First Name:JOELLYN
Middle Name:M
Last Name:SCHIPPER
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3338 DELANO ST
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-9406
Mailing Address - Country:US
Mailing Address - Phone:269-686-8256
Mailing Address - Fax:269-673-6773
Practice Address - Street 1:115 LOCUST ST
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-1301
Practice Address - Country:US
Practice Address - Phone:269-673-4188
Practice Address - Fax:269-673-6773
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI310101050361022OtherPTCB NUMBER