Provider Demographics
NPI:1215222427
Name:LIPPMANN, LEANNE CAROLINE (RPH)
Entity Type:Individual
Prefix:MS
First Name:LEANNE
Middle Name:CAROLINE
Last Name:LIPPMANN
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 1:660 N EDWARDS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-4595
Mailing Address - Country:US
Mailing Address - Phone:262-248-5611
Mailing Address - Fax:
Practice Address - Street 1:660 N EDWARDS BLVD
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-4595
Practice Address - Country:US
Practice Address - Phone:262-248-5611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8728-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist