Provider Demographics
NPI:1518562206
Name:ZIPPAY, CHANTHA MAO (RPH)
Entity Type:Individual
Prefix:
First Name:CHANTHA
Middle Name:MAO
Last Name:ZIPPAY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:691 VIOLET ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-6244
Mailing Address - Country:US
Mailing Address - Phone:850-309-7305
Mailing Address - Fax:
Practice Address - Street 1:3479 THOMASVILLE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-3425
Practice Address - Country:US
Practice Address - Phone:850-893-0459
Practice Address - Fax:850-893-6381
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0030867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist