Provider Demographics
NPI:1326162892
Name:LIPOVAC, DENIS (RPH)
Entity Type:Individual
Prefix:MR
First Name:DENIS
Middle Name:
Last Name:LIPOVAC
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 1:124 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3532
Mailing Address - Country:US
Mailing Address - Phone:631-482-1160
Mailing Address - Fax:631-482-1159
Practice Address - Street 1:124 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3532
Practice Address - Country:US
Practice Address - Phone:631-482-1160
Practice Address - Fax:631-482-1159
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist