Provider Demographics
NPI:1578887907
Name:LIPPMAN, WAYNE IRA (RPH)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:IRA
Last Name:LIPPMAN
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 1:3310 FILLMORE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4814
Mailing Address - Country:US
Mailing Address - Phone:718-645-4364
Mailing Address - Fax:
Practice Address - Street 1:89 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3601
Practice Address - Country:US
Practice Address - Phone:718-638-4053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-13
Last Update Date:2010-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist