Provider Demographics
NPI:1114564069
Name:TIPPLE, CAITLIN ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:ANN
Last Name:TIPPLE
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 1:2449 W KETTLEMAN LN
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-4124
Mailing Address - Country:US
Mailing Address - Phone:209-367-7875
Mailing Address - Fax:
Practice Address - Street 1:2449 W KETTLEMAN LN
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-4124
Practice Address - Country:US
Practice Address - Phone:209-367-7875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist