Provider Demographics
NPI:1164022307
Name:KIPP, JENNIFER LEILANI (RPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEILANI
Last Name:KIPP
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N LONDONDERRY SQ
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-3904
Mailing Address - Country:US
Mailing Address - Phone:717-838-7761
Mailing Address - Fax:717-838-9081
Practice Address - Street 1:100 N LONDONDERRY SQ
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:PA
Practice Address - Zip Code:17078-3904
Practice Address - Country:US
Practice Address - Phone:717-838-7761
Practice Address - Fax:717-838-9081
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044195L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist