Provider Demographics
NPI:1225367782
Name:WIPPRECHT, TIMOTHY CRAIG (RPH)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:CRAIG
Last Name:WIPPRECHT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 W BELL RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3530
Mailing Address - Country:US
Mailing Address - Phone:602-938-2600
Mailing Address - Fax:602-978-6158
Practice Address - Street 1:4315 W BELL RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3530
Practice Address - Country:US
Practice Address - Phone:602-938-2600
Practice Address - Fax:602-978-6158
Is Sole Proprietor?:No
Enumeration Date:2009-12-12
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist