Provider Demographics
NPI:1164602827
Name:TIPPS, DARLA SUE (DPH)
Entity Type:Individual
Prefix:MRS
First Name:DARLA
Middle Name:SUE
Last Name:TIPPS
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S GARNETT RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74128-1805
Mailing Address - Country:US
Mailing Address - Phone:918-438-4257
Mailing Address - Fax:918-438-8016
Practice Address - Street 1:201 S GARNETT RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74128-1805
Practice Address - Country:US
Practice Address - Phone:918-438-4257
Practice Address - Fax:918-438-8016
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-11
Last Update Date:2007-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10737OtherSTATE PHARMACY LICENSE