Provider Demographics
NPI:1467903492
Name:RUPPEL, LON STEVEN (RPH)
Entity Type:Individual
Prefix:
First Name:LON
Middle Name:STEVEN
Last Name:RUPPEL
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 1:5880 S BOB WHITE DRIVE
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:MI
Mailing Address - Zip Code:48074
Mailing Address - Country:US
Mailing Address - Phone:810-941-8286
Mailing Address - Fax:
Practice Address - Street 1:4845 24TH AVE
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3407
Practice Address - Country:US
Practice Address - Phone:810-385-7747
Practice Address - Fax:810-385-4679
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302026224OtherPHARMACIST LICENSE