Provider Demographics
NPI:1235731951
Name:RIPPIN, SHAWN PAUL (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:PAUL
Last Name:RIPPIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 S PHILADELPHIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-3613
Mailing Address - Country:US
Mailing Address - Phone:410-273-9203
Mailing Address - Fax:
Practice Address - Street 1:645 S PHILADELPHIA BLVD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-3613
Practice Address - Country:US
Practice Address - Phone:410-273-9203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist