Provider Demographics
NPI:1508209099
Name:LIPPMANN, JORDAN MICHAEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:MICHAEL
Last Name:LIPPMANN
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 1:1280 DANA DR
Mailing Address - Street 2:T-0615
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-4038
Mailing Address - Country:US
Mailing Address - Phone:530-223-0123
Mailing Address - Fax:
Practice Address - Street 1:1280 DANA DR
Practice Address - Street 2:T-0615
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-4038
Practice Address - Country:US
Practice Address - Phone:530-223-0123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist