Provider Demographics
NPI:1467449330
Name:VAN RIPER, GARY CORNELIUS (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:CORNELIUS
Last Name:VAN RIPER
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 1:2027 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-5404
Mailing Address - Country:US
Mailing Address - Phone:605-692-4991
Mailing Address - Fax:605-688-6232
Practice Address - Street 1:2027 LAUREL LN
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-5404
Practice Address - Country:US
Practice Address - Phone:605-692-4991
Practice Address - Fax:605-688-6232
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3704183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist