Provider Demographics
NPI:1114200367
Name:CHIPMAN, DESIREE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:
Last Name:CHIPMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 N WILSON WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205-4272
Mailing Address - Country:US
Mailing Address - Phone:209-467-7861
Mailing Address - Fax:209-467-0539
Practice Address - Street 1:678 N WILSON WAY
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-4272
Practice Address - Country:US
Practice Address - Phone:209-467-7861
Practice Address - Fax:209-467-0539
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist